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APPLICATION FOR WELL,"Nip PERMIT <br /> JAN JOAOUIN COUNTY PUBLIC UEALTN SERVIesdA <br /> ENVIRONMENTAL <br /> P 0 BOX 968,446 N•EAN JOAOUIN:T,ETOCRTON.CA 152201-M <br /> (201146tU20 <br /> AiLE� NY.ireu a -- <br /> AMNICATIOM aMETE*v MAGE TO <br /> THE*M OITY loll Are To �`T14U*y <br /> � " Ty OEVELOPLIN?TRLE,CNA►TEl1*•111C 1.3 iVp TME fIAMT C �OWALL TW <br /> Y 1 a" DN WtV,p,—, APPLICATION q <br /> Ax ADoltKbn�/��f 1 • a h7MJC HEALTH eEM10E/,pNwpMEE11AL I MTM ,,WKADWAS MR►M EAM <br /> CrTy <br /> COMTnACTp1 l•>,f4�`�rl T.�,t- A L Nr. r <br /> ON `" ^y �-1 •mac AoolEs��4 �aME/_ <br /> nr- uc/ <br /> AoolEa38t,E M ...�1 C. LA now <br /> ZYrL'-a�,m ❑,eW Ws, 13 <br /> ++�.�+uL►�OME IZdt�rr�f <br /> 13M*TALLATION O WNL emmuFW,R 0-moMp WNL, E3 oTNe1 <br /> El <br /> C3%,* M.F• ip- YH;' O11DNtOMEC►IBAl11 ❑VAPOR-r-=TWN VWjU <br /> rtrrE or Ra m m, .�1—ZL_ L DW M IVNI EET—T. J <br /> Filar WATNI ItVEt <br /> ❑OVFdF-/EMVICE WELL E3oEMNyMCAL WILL/ '—•_—� O <br /> O DE*raA:rgN; OQ *oE.*Daae�iP-1 d N1•L / <br /> 11 MDUOTMAL ❑OPEM EOTTOM <br /> 13 OO 01MA WATE ❑ML►VS►AMI., M'of W�OICAVATION ♦ DIA.Of COIDUC•TOn CAMNo _ A <br /> O"NUM MONCrAL "VM TYPE w eANMpM®]qa OIA.OF WNL CAMM9 <br /> GADUT MAL PUMRD:[I V <br /> mom <br /> � ONI .. M. T <br /> ❑y*MeATIOWA* 00TWH OEM OF <br /> OW UAL �_ 11 MECfICAT1ON <br /> AP <br /> MTOMa o1101fT MMIIO MAUI E <br /> APPMIL on►N=j�i t'a'� 2..i�G COMCRIT P—wAL-wwim O V- �N. a <br /> LomasCIE*T*n*oxaTovE/wE_ A <br /> ^101'Osss oolMTMucTaM+alwl*N*METIIOp; MID IIOTAIry AM laTMya <br /> ��_CASLE oTNEn <br /> I KKATERM CBCOW OF THAT 1 HAVE INOIAIM T111*APFIICATION AMB THAT TIE WORK WEL M DONE M ACCOIMANCE i m*M AAOUIk <br /> ReIMTIda OF TNI*AM A7AOlN1 COUNTY.MOLE WAM M On LICMlMO Aa,"MPMATIME CMI►Nry THE COUNTY On0*IANCE*•*TATE UWy*.AMD aAlt AMD <br /> TIN P UVA a 1**UEO,1 NNIAIL NOT EMPLOY V M W GULMT TO NFMUOEAM'*COEMMA"M LAWS Of C FDLLOWOIOe Y CORIFY THAT M THE PBr01O1ANCE OF THE WOI*I FOn WNICN <br /> THE nOILOMOI*: •I C"M"THAT M TIE Of TME VMW FOR M1FOlalk'COMTMACTOWS WPM On�'COMTNACTMO*aMATU1O CORK* <br /> CAL 111114A,• 'E AFPt1O MUST CALL IMI M ADVANN NM Wi11Cl1 TM FNINOT a�'1 MWL EAMUW PPA* M*lM,—TO WOMEMA"OOMPOaATIOM LAW*Of <br /> ALL IIEe1*Ile"W—Ur""AT I**q•**�N>!t.COVAM OAAVANS AT LO WOI MEA PND%MM. <br /> M"" . ' '� TM. �L`t-�u�►c"� <br /> PLOT KAN Dtiw M 9-W*.r. •e. E-•= 4 <br /> 1• of*TOWT*On FlOAO*NEME*T To on*OUNDOI*TIE FrApo y. <br /> :.OHTINE Of TIE rIIOPEITTY.MVM POWWOW AND MOWN O*OCTIOM. /.LOCATKW or M NOL MWAOE 0W O*AL*y"M on FIIDF'o*EO <br /> 7.OOWWOMO OUTLM[*AND LOCATIOM or ALL OU TM OM A D PIaPTI*EO ]OWAMMOF MWAOE ONIMMAL*Y*TEM*. <br /> *T1111CTIMEf*,0CLIID*Ie COVIUM MEA{W M M►ATDNL OWAWAY*`.AID WALK*. t.LOCATION OF WELL*WRNN RAO*a OF ONE IAIII0INlD FMTY FT. <br /> ON"it MOPE"90..:............; ...........;............:.. <br /> .............:......e............e ....�......e... .�......:...... <br /> ... .. <br /> . ...... <br /> .......e.. .... :....... <br /> ' ......... ....... : + MAMA <br /> ......... <br /> . .;.... ....:... ..... <br /> ........... ........ ...: <br /> ............ <br /> .. <br /> ....... <br /> ............ <br /> .. <br /> .:.:....:... <br /> ..... <br /> :: ::: ............ <br /> ...... . <br /> ......:.... <br /> ... ... .. <br /> ................ <br /> . .... ....... ......... .......:........ :......... <br /> J.CSC L�+ ...... .<...-. i�...€.... <br /> 'If- nA..aeda 1A' (I ` ((�M>FJY�. �AIITMIBFr wECMIr /j ( '1 A..� <br /> otic Mrf.+rn By OM. ftiA►I�.P.Mbn M `j DMe <br /> CMniwnM: <br /> ACCOUN M*ONLY: AKNF FAC/ <br /> Room FIE Aro ANOUNTZONenss 01*CR/0CAM1 MCOVID BY DATE PO*1OTNEi1yIO*1 GUM MtMO1 NVMDE <br /> N c� <br />