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APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 3881 VX EAST WEBER AVENUE,STOCKTON.CA 95201388 <br /> 12091461-3420 <br /> MONREFUMOAILE PERMIT FYDIAES 1 PEAR FROM DATE ISSUED <br /> Ic"76-1/IR T,k-ksl/) <br /> APM\CATION M IRR*BY MAGE TO DE SAN JOAOUM COUNTY FOR A PERMIT TO CONSTRUCT AAMMA INSTALL THE WOW DEF•CI09FD.THIS AFIEICATION IS MME IN C .,LIANCf"fit SAN <br /> JOAOLRN COL.'NTY OFVROII.IFNT iRLE,CHAFFER 9 1116.7 AND THE Sf MS OF SAN MAMM rOUNTY LIC IRALTIf SERVICES.Fl VIIgNMFNTAL"KAITR OIVIIMN. <br /> J0I ACOREOILMA APNF4A Xc�rrt i pAICR w7F/AMI <br /> DENIER'S NN.If AOUn[6I <br /> • <br /> CONTRACTOR AOOR[FS _p,[OEE f✓<YS T� <br /> lRlII <br /> CONTRACTOR ADTMES/ VC/ ARAN[/ <br /> TEFF OF MEI ❑HEM YYElI Cl MFMACIMENT WILL ❑HONRO-N(I WELL/ ❑OTHER <br /> F❑T/M�J�LUIION ❑WELL 8,FIT FM TEPNR ❑CI109E CONNE/r�T RF EI.^ROR ERTRAC',MN WELL I <br /> OF <br /> YHwr lJ ll,a.ir H.P.`� OF 1-IH IV Mn9fP" FIRST WATER LF VEL 1�1 <br /> // O <br /> plKlpl I <br /> ❑OUT OT I[RVICEWILL ❑OFnArvPMAI WILL I ❑ {OIL So-:J!" <br /> IN101 fYP! WFll CGVI{TRVCi1DN{PECIHCAIIONI A <br /> FRfTTl B�UST FSA\ ❑GRN90 TTOM DIA.Cf WF II I X C AV AT MN till'.GF CONOM TOR C ASMO D v <br /> W.fR)MFRTfCA VAT* ❑NLAVEL rA"lSQ[ TYPF nF CARIIMMTFrt R' - dA,Of WILL CASINO_ O <br /> (]N16LICM11111[AAl ❑pIKViN OEM" OROHT If AL <br /> ❑ IIFCNICAT/L/N R F� <br /> IIEIGAIIONIAG ❑Of/PER ORn,IT FEAL INSTALLED 1Y- OROUT RRANO NAME F <br /> ❑MONIT OfINO OROUT SFAI PuMAD ❑Y- DN- CONCFIETE NDESTAL BY ORILLEN❑Y— ❑W <br /> A"-IC■ DFRN LOIKING CW-FR"XMOVE mm <br /> IR MSW CONITIRICTIONRMSLLFNO METHOD:MUOROtAW_ AMROTATY AUGER _CABSF. OTHER <br /> 1111'EIY CERTIFY THAT I IIAVF PRIPAFED TMS APPLICAlMN AND THAT THE WORK WILL IE OONF M ACCOIAIAWF WITH SAN JOADUIN CDIAVfY 06IlINANClt.9TATF LAWS.ANO RULES AMD <br /> IEOLRATIONII OF THE RAN"AOVIIN COUNTY,NOME OWNER OR L1 FIrSFD AOFAR'I BNTNAIURF Ci RTIIEA T11[fou r.wwm:"I CERTIFY THAT IN THE PFTEOPMANCE OF Riff WOIR TOR MRIICN <br /> If"PERMIT IS ISSUEO.I w1ALL"Of fMROY RERpNI 9umJFCT TO WdIKMAMA COMPERSATMN LAWS OF CALNOMNIA.'COMRAC TOR'S fKw NO OR/VE.CONTRA"w"IMNATUIS[CEh11FIFS <br /> 711[FOLLOWING• I CFRTEY THAI M it RFOMJANrt OF THE WOII[FOR=11 1109 MRWT 10111WFD.1 SHALL EMPLOY NRIIONS SUBJECT TO WOMMAN'{COMNNIA7gN LAWS or <br /> CAUFORM 7 CANT VS7 CA JPD 1N AJ7VANCI IM AL:IIaVMEp IN//I�a�./�1��n��N/AT 17051 SII-SSff.COMRETF(MUWRq A7 LDW[11 NEA 9FEIYKIF/OT, <br /> TUI,. / <br /> RO rO,—,.MY.r Sew. 'tF <br /> 1.M OF STRRI OR ROADS NEAREST TO OR THE PIRONTTY. --^— A.LOCATION OF"MUSE SEWAGE me,,,eAL IYSIFM OR 1'11IlIO R[O <br /> 7.OUTLINE OF INF ARONRT Y,GIVING TRMFN,,ONS AFT ,jqH DNIIOTMN. EXPANSION OF/[NAGE DIIVR)\µFYSTEMI. <br /> ].OLM"NlOMID OUTLII"I AND LOCAMN OF ALL EJOSTINO ANSI r",,MUFO S.LOCAIMN OF WELLS WITHIN 11AOIUI OF 061E HUNOFEO FIFTY FT. <br /> STRUCTURES.IICIVOI K)COVETED AREAS I ICH AS FAT101.DIIVEWAYS,AND WALKR. ON THE PROPERTY OR A0,100"NO PROPERTY. <br /> A 0 <br /> I SDI <br /> PAYMENT <br /> RECEIVED <br /> 4Aal r MAY -119% <br /> a SeAN JCAQUIN'Cclm-y <br /> CHEAITHIRVICES <br /> FNVIgpNKTNTAL HEALTH ON SION <br /> DI/RATS rWF OMIT' <br /> AFFIRR,f—A-W d 1i /b�H• �� _'� Gi a�,'JI h.A Q� <br /> De.,r,s,IRn l•.F-ew,eF— ---- D.r. <br /> AOCO VNn NG OMIn AME <br /> fAf R <br /> N COOFI FEE INFO AMOLINT REFATTED /1[[K CA{H l RECOVFD IY DATE ►BwElIA191NCE REOtUF/I WUMVIRR INVOK{ <br /> Pub.HeehD Se(y.-Enviro.173(3,%) <br />