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'�ryI <br /> ry " APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 368, 446 N. SAN JDABUIN ST., STOCKTON, CA 9520/369 <br /> (2091468-3420 <br /> NOW PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICOMPIMS in TripINBIBI <br /> APPLICATION IS HERE BY MADE TO THE CAN JOAQUIN COUNTY FOR A PERMIT TO IS APPLICATION <br /> MADE <br /> JOAQUIN COUNTY D[ EN 91115.3 AND THE STANDARDS OF SAN JOAQUINCOUNTYPUBLIC HEALTH SERVICES,HFIRAIRNMUNTALIHEALTH IDIVISION. <br /> AxcEwnH snx <br /> JOB ADUREse RMS L404 West Fremont StreetCO,. Stockton EL SIZE <br /> OWNERS ME Crystal Cream E Butter ADDRESS1013 D Street . Sac . ONE . 444-7200 <br /> CONTRACroRWallace- Kuhl 8 Associates Axmag3050 Industrial Blvdf-W Rt acnIONE ,372-1434 <br /> X IDOL! <br /> Bus COxTw.Cro�'laE'9�tfX-' V BPAW 11 _ o AU Oar 552198E . 373-1118 <br /> TYPECIFINEEMaeumr: ❑ NWELL 11REPIAC l� LIoNTRAINO LE MW7 13 OTHER <br /> EW❑ N TA"TION ❑ WELL SYSTEM REMAIN ❑ CRUSSCORNECT REPAIR ❑ VAPOR EXTRACTION VVELL Ir <br /> ❑ 11two RBA.I, H.P. DEPTH PUMPBe —". Pw wATEn L 25 feet O a <br /> mMEOPwMry ❑ OUTOFSERVICEWELL 13 GEOPHYSICAL VA 11 BOIL Bo e <br /> ❑ oEerwnl u e <br /> INTENDED We TYPEMWEU. SON <br /> 11 INDUSTRIAL ❑ GLEN BOTTOM $—Inch DM. or CONDUCTOR CASING 411 D <br /> ❑ DOMEOTICRUIVATE 19 GRAVELpACKIweE # 3 Sand TYMOrCAAGIGISTHEITTVC PVC CIA, OF WED. CASINO 211 D <br /> ❑ PUBUC UNICIPAL ❑ Ory VEN COST H OFB AL 21 feet oforcirICATION 0111 <br /> 13 woGATTIRwAn ❑ BTHER GROUT SEAL INSTALLEOny. Trelnie a IAB yy..++ _ .D, aBA1ERA( <br /> IXMON o GROUT EAI. PED-)MM El No CONCRETEPEB BVusvOrvum:�v. ❑wOw <br /> ANIGNI. Dartat 40 Feet LOCKING CHMF" BOx BTO <br /> VE NINE <br /> PROPDSPD CONB"WVGNm WNO METHOD. MUD ROrARY AIR BOT X cAnLEL. OTHER <br /> I HEREBY CERTIFY THAT I PIAVE PREPAIM) THIS APPLICATION ANN THAI THE WOW WIRIL W, NONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES, MATE LAWG, AND FAILES am <br /> PUGUILATIONSOFTHESANJOAMANCOUNTY. HOME OWNER OR UCrNSED AGENT'S SIGNATURE CITTITIFIEG THE M�Nd, 'I CERTIFY THAT IN THE FEROMPANCE OFTFIE WORK FORWHICTI <br /> THIMPERMIT 18 ISSUED, I SHAM GOT EMPLOY FBIRMONS SUBJECT TO WORRMAN-6 COMPMEA710M "WE OF CALIFORNIA.' CoMnAcTOR 8 HIRING OR OUR CONTRACTING SPINTIATURE CITTINES <br /> CAUTO `ANTTMMUST PERFORMANCE <br /> N ADVANCE Pati ALL REQUIRED THE WOM FOR MUCH m.Pwn ANA. so.i 4684PRa mrnur REASONS <br /> B AT LOWER AMSUBJECT TO AHmovuEOPx.AnOx "We Or <br /> Boom X O�+IC.�C Av`LL /�tsr�_ ---�.^ TUI. 'z oTl_ crlG Eui �415T - WkA H wre-2 - 9S, <br /> FLAT FILAN (Droor to mos) S"Ier to <br /> 1. NAMES OF STREET$ OR MASS NEAREST TO OR BOUNCING THE M�. 4. LOCATION OF HOUSE BOARDS DISPOSAL SYSTEM 09 FROPOSED <br /> 2. OUTILINE OF THE �MM, GIVING DIMENSIONS AND NOUN DIRECTION. "PMMON OF GINVAGE DISPORAL SYSTEMS. <br /> 3. DIMENGUNIED OUTLINES AND LOCATION OF ALI EXISTING SAO THOPOSPI) S. LOCATION OF WQUa WWRIN FAIDIUS OF ONE HUNDRED FIFTY IT. <br /> STRUCTURES, INCLUDING COWPER AREAS SUCH AS PATIOS, OM�AYS, AND WAMS. ON THE FROUPOoff OR ADJOIPUNG PROPERTY. <br /> F2EPIONY CTREET- <br /> _ -� pR0PR5 ED . <br /> 171r£ mmSTORM nRDui <br /> yYIGH VUI. TaG E - tIAI J: <br /> NTILITT POLE : 11 <br /> N - (1MEEICAV PROTECTIVE PDX <br /> (WAT ER TIL <br /> SE ¢ulc F_i -. RLD G. 9 - 1- <br /> w <br /> W <br /> - 03 . <br /> 5cul2 : TP. i'I" . <br /> . B <br /> O 10 2 <br /> Accepted BY DEPARTMENT USE ONLY d <br /> ApplicationGAS Arm <br /> Grew Irverawflon By Dote Pump Impaction By. <br /> MIS <br /> Clearwater Inamobn 0 Date <br /> Carnmorats <br /> ACCOUNTING ONLY: AIDE rAC# <br /> PEDOMe INFO MOUNT REMITTED HD3L AmsD DAM <br />