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APPLICATION FOR MIELLIPUMP PERMIT <br /> SAN JOAQUIN COUNT'PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 31I,445 N.SAN JOAQUIN ST,STOCIRON.CA ISN14N <br /> (m)488400 <br /> NOEIEFONOAILE P[IIIRT O PM 1 RAIZ FROM NAR IMID <br /> rA111*111d ID TIVISS y <br /> APgKAT10N IS HEN N MADE TO THE SAN JOADI"COUNTY FOR A FVWrT TO CONCTINCT AND/OR N(TALL THE W014K DESCIVIED.TIN AFPLJCATION 16 MADE N COWLIANCE WITH SAN <br /> JOADAIIN COUNTY DEVa.0ftff TTTITTIW <br /> E..CIEE116RRDS IMN <br /> 1115.3 AND THE STANDAAOF SAN JOAON COUNTY SUC HEALTH I ENLACES.ENNMNSENTAL HEALTN INOWN. <br /> JDS ADOKOMpI AFNI 39576-_/. Q A/ � APS!'. CRY T�� �<� /, lA.�.. A.N. �/ p..J <br /> aWAA"NAW_!p ..y 112AJ ILJpj Jy 2�y fi� ADONJE?1�i(r S*__P.S/c LY'rT/atw CfS3 AHOEE•Els_10 Jpra• <br /> ooNTn�cTv�ia$rr 1L.ti rt/lC..e ADORE" i�uci r.nN�• ���i <br /> PUP CONTINCTOA AONEN 3-,� LICE HIOJE E <br /> TYPE OF WE Gem ❑NEW WELL ❑REKACEIAENT WELL ❑AAoomomwo WELL ❑OTHEr <br /> ❑W4TALLATION ❑weLL aY EM KPAUR ❑CROSSLJOE <br /> OwNecT FWFAM ❑VAA XTRACTYJN WELL• ,/ <br /> SubA ❑ LR-AMrN. H➢. OEPfHFU1KlET�J2Ff. POINT WATFA T1 Je ' 0 <br /> (TYK OF"A.) <br /> ❑OUT�AETNIcE WELL ❑OLOFI/YSCM W91 I ❑ ADE SOTwcE a <br /> ❑DwrwxTION <br /> : <br /> Ru A <br /> 11INce, UL ❑OJEH EOT-DAJ SAA.OF WELL EXCAVATION ORA.OF CONDUCTOR CANAD O <br /> ❑DOMLifICJPIIVATE ❑SMVAL FACKM= TYK OF CASIPHUM ANC IMA.OF W6L CANTO O <br /> ❑Pusim MNICJPAI ❑ORKN DEPTH OF UNOUT SAL SPEOECATION R <br /> ❑WOMATK WAS ❑OTHER OAOUT SEUL INSTALLED SY EMOTE WLAW MAA! S <br /> ❑MoNEmmw c+OUT SEAL PUL*gD.❑YAF ❑N. DoNUIETE mbmAL W DIIu#x❑Y_ ❑N. t <br /> ATNIOX.OYTH _ LCGIISM CHESTER SOXATTOK FIRS <br /> /IIOPOSO COTISTTSKTWNIDFKINS MEflIDR MUD NOT AAV A l IKTAM` AUOFTI _CASLK_OTHM <br /> I HU%NY CUNFY T1 T 1 HAVE FIEPARO THIS APPLICATION AND THAT THE WORK Ml EE OOZE W ACCORDANCE VM4 SM J004RM COUNTY 01DWANCEY,STATE LAWS.AND Fun AND W <br /> RE'OUlJIT1ONS OF THE SM JDAOIIN COUNTY.HOME ONNEFI 09 LICENSED AGENT'S 4ONATLK CIMTW*$THE FOLLOINWO:'I CERTWV THAT N THE F6EORNA CE OF THE WOISC TOR 1M11CJ1 �L <br /> THIS FOUNT IS ISSUED.I EULLl NOT 04 OY POEOW MLLIECT TO WNSSAMY COA/EEATIOM LAWS OF CAIE'OINi A.'CONTFIACTORY HEISTS DA N!<COKTIIACTINO SIONIITURE CERTME ✓� <br /> T1E FOLLOWMS: 'I COMPY THAT N THE FDIDIEANCE OF THE WOW FOR WHICH THIS FOUNT IS ISSUED.I WALL PNNDV FaISDNS SL UNICT TO WL'S COMwA71ION LAWS OF �+ <br /> CALFONEIi' THYPPIMAIST MUST CML K IDMS M ADVAHCS PEM ALL AEOUSIM IMSPCTNH S AT 17N1 ANANIMIL COl/IETE OAAMNS AT LOWM ANA PROUD®. K] <br /> PWT PLAN 0,—1...0W S..1. 'b_� _lc— <br /> I. I/ANtlI Oi lIFI[FITI OA IDADS NE111EHf 70 DR SOUITD1110 TIE FIOPERT':. S.LOCATION OF HOUR SEWAGE DISPOSAL SYMNI OR PROPOIND cl <br /> 2.OURLFIE OF THE FIIOPAPTTY,0P ND DUMNE111UN9 ANO NORM RECTION. EXPANSION OF WWASE DISPOSAL WrWtUkN, <br /> .1.DIIflJEOAEO EHRUI NSI InG.—OF NL EXIHTIM AIA)NOOSED S.LOCATION OF VALLS MTHIIN RADIUS OF ONE HU 10"D FFTY FT. <br /> STRUCTURES.INCLUDING COVEKD AFEAE SUCH AS PATIOS,D RYIEWAYS,ANLI WALI[S. ON THE FWFOITY DA ADJOSSNO IMF"". [Ta <br /> 7 <br /> 7 3. <br /> ... ... .... .. .... <br /> v 1 , <br /> .. ._. _. ._ ... .. .......... ............. ... .... . <br /> r <br /> �. ...._.q _ PAYMENT <br /> _... ` . .. ....... __ <br /> MAR 2 3 1999 <br /> :. <br /> . _. <br /> SAN JflAOU(NCOUNTY <br /> ' PUl3UC HEALTH!,F-RVICE.S <br /> Ef1VIRONfJENTAt Hl:Atl'W DTVI O. <br /> DSMnrh%W NO ONLY <br /> AA.WLR.A.­W ST D.a 77-/ Z Nw Z <br /> o.KA k. Ion O, O.. PV.F Ww l..S. <br /> ON*lFn.n Inw�Il.n EN OSI. <br /> ACCOMITINJ ONLY. NDP FACJ <br /> !' <br /> h COD4 FH INFO AIAOINT REMITTm OM{+LIVKASM IECENm ST DATE !AEOIEST SPFL'ICE <br /> Lf J90 o Z <br />