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APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOtAMMDAILF IEAMT EAD1AES 1 YEAR FA019 DAT!If1UED <br /> IG■�InI I■Tr�0nIs1 <br /> APRICATION IS I[W BY IAAM TO TM BAN JOAMM COLMTY FOA A PFNMT TO CONSTMXT ANO(O"1NETALL THE WORK OEBCRIBM.TIN(APPLICATION Ht MADE N•:OMPLIANCE WITH BAN <br /> JOAOUN CVJN`tY 0"LOPMENT TITLE,C14APITM I-111 55.3 AND THE BIANO ARO■OF BAN JOAMM COUNTY PPUBLLIICC [JILA <br /> HLALTH sCES,FNVIOIAAENTAL RMTH bA,ASION. <br /> Job—nMOI.ORAPIQ w,/ QLFA�(� 0() cay 7&!1(7v ���j PAR1Cn■IzuAml `�/I7 may` <br /> OWWRY■NAME r' S,.L-��1/T�. �- Apv(■■a9���y01 [�'+ (�� ���•���<y<f..1ry� RIONEA /1e7n/JJ� <br /> CONTRACTOR l fXJ.drT'/l.L'� ���T l-M ADDiEntiJ/� i u_l�d�va���l L�YILPPIONF[J7 � <br /> ■UBCOMAACTON ADDRIM 'uc.— RIONE <br /> TYPE OF MSu/1'LIM1, AUT-Tt H[W wm IJ fPLA.CM4`NT VIRt LJ&4owofRRO Noll f DTHcK <br /> U NBr Al1ATKm r-]WELL sYSIEM RFrAN ❑CROSS-CONNECT RFPAW ❑VAPOR EX fRACTION WELL/ J <br /> ❑H—C1RTP+ H,►. DEPTHR BET TT, FAMTWATFEIL[VEL 0 <br /> Dm OF Pv"m �-{ -- <br /> (� ❑O/^VST/O—f tIET/vlct`N{Eu 0 OEQPHvNw.LLL WELL E ,Cl BOB."O"NO / R <br /> E*T TON' LLQ `(�Y�1 L <br /> --.L—J ''/1 — �9-4j2RIA <br /> T mqqNsTRmIlOh 1 t"c A <br /> ❑INOUBTISAL ❑OPENbOrIOM DIA.Of,WELL EXCAVATION 01A.0FCONOUCTOR CAWNO D <br /> 0DO1,42TICIPNVATE ❑�TOMVELFACK/BTZE TYPE OF CA%IHORITIFt/►VC DIA.OFVM(CAVNQ D <br /> D R/SUCAAlMCmAI L o"N DEPTH OF OROI SEAL _ %PECIFICAMN A <br /> ❑IRPMATIOWAR ❑OTTRR OIIOUT RAL NNTALIID BY I-I ORIOUT BRAND NAME I-, f <br /> NT <br /> ❑MOoWNO GROW RLRI <br /> AL PPEO-11Y— Q TN. COMPETE FEDWAL n ONLIM-❑Y« ❑N. s <br /> APPROS.DEPTH Lomm CMSTER■OR/BTOVE RPE s <br /> PROPOSED COMSTINJI,RON/OISl11ND MBTTO0,MUD ROTARY AIR ROTAAY AUGER CAml wmeq _ <br /> N <br /> 111lEBY CERTF/THAT 1 HAVE pE►ART)TNN APPEICATON IJIO THAT T'IE[1NOFR N'RL bE DONE N ACCOAOANCi WRN BAN AAOtM COUNTY ORONANC[S.IIAi[U,A'I.AND R1Rf/AND <br /> IEOULAM-11 OF THE BAN JOAOUN C*Uwv.0044~"OR LRC(NRD AGENT•■AONATUM CFATIFE■TIE FOLLOWWB :'I CERTIFY THAT N TM PtVIDRI AMM OF THE Wow FOR WIICH � <br /> TNSPFMIr N Hulmn,1 WALL ROT tNIPL PERSONB SIIUECI TO BMRILMAWN COMPBNBAPION LAWS OF CALWANA.'CONTTACTOWII WRI NO OR SUB LOMAACTIRA BKI/AATUE CURIES !,_ <br /> TH(FOILOWIN alTHAT N E L!OF TIIE YEOISL FOR WNICN TNN PE RS NSIICJ.1 WALL E11PlOY PERSONB/UBIECT TO N'OISIMMY COAIP'fIATNN UWB OF <br /> CALJfO T MINT C N fA6 N ADVARV41 FYTA ALL 11l4TA1t®IN IFI A/ 1OP.f/71 /�PSAVA AO AT LDV*R NEA PPPDVsI[TI. <br /> Blln.s% - TIED_ "t"m� � Or. n <br /> FLA R v—,.MMM w. <br /> i.NAMES Of STREETS M ROADS NEATEST TO OR n0}TINE MOftRTY. A.LOCATION OF Hp1JSE sFWAOE ONPOBAL BYBTEM OR PROIOS(O <br /> T.OUTLIVE OF TM PPOPPMY,OIVINO DW400M AND NORTH ORECTON. (XRANIION Of BEWAOE M'OBAt BYBTEMS. <br /> T.DM[NSKRED OUTLINES AND LOCATION-NJL ex—AND EL <br /> PROPOSED S.LOCATION OF WIJE WmORJ <br /> AN RAI OF ONE M NDIEb FIFTY F-T N <br /> ■TRUCT77Rs,mum"fO COv"m A1EAS MICH AS PAT$08.ORVEWAYS,AND WAULI. ON TM PMPEIITY OR ADANRq PROPERTY. 1TI <br /> s <br /> . I .off rt <br /> wElc¢3 {/AC0gl �Y <br /> rZ11- <br /> D�fr <br /> JUk 17 1998 <br /> SAN JCIAUUI <br /> ENyfgGNME1yTAL HEAL H/pl i.IK� <br /> DbARTMBIT UI!ONIt <br /> A�.n1.O Awy1Pd BY_ bSIB hPP— <br /> a.w VnPre...y_ Ow. R.nP k.■P.aII.n BT OMS <br /> J �TroaJ O. <br /> ACCOIMHNo ONLY;J AIDE ` FACE <br /> P[COOL FFR INTO AMOUNT"Wr TLD CIRC ANN R...■Y PATE PIR"IMMBNVICE R■OIRST NI IAM INVOICE <br /> 7 Y/ <br /> Pub -ea101 Ser,-Envfm,173(1197) A' <br />