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APPLICATION FOR WEWPUMP PERMIT <br /> �( SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> \ ENVIRONMENTAL HEALTH DIVISION i <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOWAEFUNDAILE►EIIMT EIIPIAH 1 rEAA F0001-DAT!MIN <br /> MeoWlete IN Triplicate) <br /> APPLICATION IN VIRE NY MADE 70 THE SAN JOAOUN COVWry FOR A P[NS.RI TO CONSTRUCT AMOOR INSTALL THE WORK Of W WEED.TMS APPLICATION IN MADE N COMPUAMCE WTTRI SAN <br /> JOAGUN COIRAY DEVELOPMENT TITTI.CMA►rEl D-1115.3 AND THE IT AWARDS OF SIV!MAOAN COUNTY PMX IIEAL1 N SERVICE[,ENVIRONMENTAL HEALTH rNMON. <br /> JON A00REIMMM Aron 10966 E. MARIPOSA ROAD n,TY PARCEL N2FAVNF <br /> OWNIFR7 NAME Brent WILLIAMS ADONEIS Stockton,, 95215 r,IO„EF 464-0279 <br /> COMMCTOR NOACi PUMP CO. W/O 19372 ApLMSS 4500 L Fremontvc[ 504513 naRREF948-8817 <br /> n —"' <br /> PVN CONTRACTOR ADfMS:Se r•y UCI iMONIE F <br /> TY►E of WELLNVAR: ❑N[LY WELL ❑IVPLAC[MT]R WaL r❑MONRONNO MILL FrL�/OWER_ <br /> (3RISTALIATR,'N ❑WT SYSTEM REPAIR U CFUS[.CnNN'FCr REPAIR E]VAAOII EIrYRACTON WfiU E J <br /> S'uu'b1m'errss''iibbllee p9N.Q,,In,,., N.P. HP rD•F"14"PSET_". F-FVIRVTWATERLEVIR D <br /> I LJ{n re RIF ❑OwnvEIIVIC[VwLt LJ GEOPHYSICAL WELL F tJ SON EDRNo e <br /> ❑DESTRUCTION; <br /> nnaMw LffpkwucN TIWCTIOM SPI'CIFICA U-0—w A <br /> ❑IWIHrf AAL ❑OPEN SOTTOM VIA.OF WELL EII CAVATIOM OIA.OF COMOMTOR CASINO O <br /> X10DOWSTICAPAVATE C]ORAVELFACKOM T-VKOFCASMMTE[UPHC CRAL OfVEntCA~ O <br /> ❑PIAXWUMICRAL ❑-I DRIVE. OEM"Of GMtff ZEAL SRCVICAT10N A <br /> IMI <br /> ❑-I OATIOWAO C1 OrRm GROUT SEAL NST AMD pY OAOtrF EMNO MAW F <br /> EJ MOMTDAMO GRROM IFAL PUMREO:❑ ry Yr LIN. CONCRETE,'FOETAL SIV MALLEI!❑Yr DN. s <br /> APPROX.SIPTM LOCKNO CHESTER IORRTOVE PIK S <br /> PROPOSE CONSRIVCTONAMLIINO METMOD!WO NO __AIR VOTARY AUOER_ CAK1 OTHER <br /> 1 NEEIY CERTIFY THAT I MAVT PRETN <br /> NI TS APgJCAT10N AND rMAr THE WINK WILL N DOW N ACCORDANCE MTH MN JOADUN COUNTY ORDINANCES,STATE LAWS,AND RULES RAID <br /> G <br /> ROATIONS Of TTS;SAN JOA OIAR COIMTY.NOW O YWS OR LICENSED AOENT'I SIONATUAR CERTSTES TM FOLLOWM!'I CERTIFY THAT N TN[PEIEOFNANCE OF THE WOFK FOR LrA" <br /> TRIS P[AMT 18 MINED,1 MALL NOT ETMROY PENNONS WMACT TO WORKMAN'S COMPORSAIION LAWS OFC.LFORMA.'CONTMCTOR'I MINIMS OR KNICONTRM-TSAS SIONATI/FE CERTNES <br /> THE FOLLWNO <br /> O ; *I CERTIFY THAT IM PRE/ <br /> ► WORAANCE Of THE WOR(FOR VA1PCM TMS PERMIT M 1.ftWJ,1 WALL EMPLOY RRNONS WMACT TO WORANAVIV COMPE/SARON LAWN OF <br /> CALF0IMA." T= <br /> A1T.IMT CAIt M NTW IR ADV I fM ALL R[4iAR[b NSPSC//�/SMS AT /W!/�I/nM JSTI�CO�M//P�ILT[pRAMRFq AT LOWRR AMA AgVq[p, <br /> KVnA A -;C Cs��' L �_ TRV._ �f4 C �!/if" <br /> PLOT RAN p.w.M..I. <br /> 1.MAMEI OF STREET•OR ROADS MEAKST TO OR IOrJI1ORM TIRE PFIOFERIY. .. LOCATION Of NOUS[SEWAGE OISPOSAI SYSTEM OR PMPONM <br /> I.OMI.OF TIE AIDPERTY,OIV*M D"W "I AND NORRN OWCYION. EXPANSION OF SEWAGE DISPO M SYSTEM. <br /> 7.MMN—NM OUTLINES AND LOCATION OF ALL.EMISTIND AMD PROPOSED S.LOCATION OF WELLI WI11NN RAAMI OF ONE WJMDPW FIFTY FT. <br /> ITRUCTUIIS,NCLVOINO COV""AREAS NUC•AI PATIOS.DNVEWAYS,AILD WAU(I. ON THE FROPEMY OR ADJOIFIND FFROPO". <br /> C' OCT 1.9 199E <br /> b5, <br /> N <br /> OVMTMFNT UI[ONLY (Y� <br /> n.In.+Nn I.wmlb� <br /> NY D.I. (((( <br /> ACCOI;NRNO ONLY: Alp/ FAGF <br /> FE COM FL[INFO AM04Kr#4"Tf[D CN[(: ICASN RECDVEO■Y DATE 1NlRIFUN6INCS RSOWJMLMI INVOICI <br /> c) <br /> Pub 64eehh SerY.-Enviro.173(1/97) <br />