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I 1� <br /> "PLICATION POP PERMIT Ir <br /> SAN JOAQU111 CatMT# tLMLLC HEALTH. SSRVICES <br /> R14 V I RIDNI.fiNTAL nVALTH b i V I S L ON <br /> 445 N HAN JOAQU IH , PRON8 (200)468-3420 <br /> HOX 2009, STOMTON, CA 95201 <br /> (Complete in Triplicate) <br /> A�littr<tiea i+ 6ire1y a"4 to flnft Jea40id Ceuatt for + p.treit to een.truet &.a /" tee theallule• biadaltatvlatieerade! dank <br /> a"He*tiea to wde !n eaaipliane• with Qac Jeaduin coue+tY Ordln�r+e• lief S 9 <br /> doe+{nia Cotletf htbfie Aee.lth ll4t-rleu. <br /> Jeb Addreea 5400 pacific Avenue city$ I r•*+ _ Lo! silt/Aereade Arlie tttegt <br /> t}M,n.r ueme <br /> Montgamerl Ward ^Add,ete ph an* <br /> .A <br /> 22& No C57���f� Pha,+a 916 <br /> Cenlrte4M,^ /1/4�'� IQ/Y__.�ddr� -� <br /> YP Q W[LL/PUMP: NEW WELL O WELL REI'LAGEMtNT gESTRUCTION ❑ �t Merlttarlr4 well <br /> PUMP INStALLATION U §YETt:M AIPAIA tl OTHEq d <br /> 011tAft tO NiAmetl 9EPtIC tANX . - - . StWtA UN�e -1 <br /> O50 _- t)15POSAL FL13 PgoP LINE <br /> t <br /> iOUNDAtION - AGAICULtUt1E WILL CTHEA WELL PIT!!/SUMPS <br /> tNTENOEp U91 type of WELL PAORUM AREA tt.lN8if4UCtI0N SPECIFICATIONS A ;..' <br /> L1 lyduetHM d 006"86116r" Menteta ble al wee EreeNat - I71+ e1 well Gslnd <br /> rl OemeellelPtIviO 0 do" PieV ti tleey Type dl Cetlne- <br /> gpeettketlenf <br /> 1 t r„bRe tilt.er 9oringAf-rl balls b4olh 61 llreut Sesl � j may, Trvtel tlreut C <br /> I 1 Intgallen 5�f 11►Ixeae tseeth I t Efilerh SUAICe Sect In:I+Mad by <br /> Abook WaA ben. Lj trpe et Pu" _. - H P Stele �(yl6rk t) d Otto <br /> Wet bNlnrltlart Ci Wel bl4rt+e111 Saeliae t4teriei a D"th eat ement $ltirr - m) <br /> ""th fillet Ihteriel i bePth <br /> Y 1 WO KI NEW INSTALLATION I 1 REPAIRIADOt=ION I 1 DESTRUCTION 1 1 I NeAebN willHn200 INtfrrJi'rd M "FIC $rwsr Is <br /> r�Arttea wtA/aMr fleetdsr,ee �.. Catrwr►eretal,_. Other <br /> e1 SvMq tulle, Number of bed6elt+4 <br /> C1drleNt of Ia1 fA 16" at i fat' water table depth <br /> No Co <br /> UPVC TANK C1 tv061m1S Cla.elly--�..-- "n t 131" 0 <br /> tl M.shed et Dlepeel <br /> ►tca tAlAtMENt Kt. <br /> MIA"64 fa hear". WON Potxtd+tlor► Prt>perty Llr,e�� <br /> LIEAC140M LINE ti No 1 WWII 61 tinea total 14noth/al:a <br /> ft"N SSo 13 0161 O to hA 611• Wan I'•eut,delbrt . property LVA <br /> 1UPAGI MO I I moth - site Nombar c <br /> NUMPS Lt tllatanN to naiteat' Well. w_. PaUndattan 1►r kIrAll RI jUl" <br /> DISPOSAL PONDS _ ❑ I_,,,It I; <br /> I I.hebT of Ihai t hew pNOeted thlf 100lleatlah and that the work*0 be dere In eeeerd.net,Willi;SIR ldhquln t: duty otdlnane!!, lift$ <br /> rale find teQuHIWA 61 the San Jee4aM eeuety <br /> Herrl$&"#*at IleenlaA AEetA'1 ltlQnilttle tairiltlei the talowinp• "I eer4ify Ihe1 ld the phldrrnlnei e1 the work tet whleh lhN permi4 le lflwd. 1 et+ell noI <br /> of S"pa:tbA In*UA mdkw* N 10 ded6wis au6fael to wdtkniin'1 eampenlitbn If*$at Cflllatnta" Contractor 1 hiring ar it;!�.eentreet"ft"Iture <br /> eerlRlee AM rofth% I "I eollFr thel In Im fiettatrninee e1 the work far*hleh thli 04WA Its laved.I thell erhplay perfon$tubfeet to wakn%"a eerroo"a <br /> Asn Mwi of Callfom 11 See Attached Figure <br /> tha 18p�ea111 !N fel M ed In4Wilma Carnpl+te drewk+e bh tevertl slide <br /> s is{6 rill trtleGeologist bate, 11/30/92 <br /> FOUR brIPAn IMEN'I'U21 ONLY <br /> iAg4lfeatteA 4111"1601Sy bite �� _ AM <br /> Ph at 0""A tA4paetleA by Data Final It,rpeetlan by bete � -- <br /> Cer++rhenla6 /IGuI S r%rAv"011east - Rattlto Ali aeplef tea UA JoRadie Ceun! bdlrlie Realth 5ervieee f� <br /> ld.ltoeeltlel RefIth Par■ittesv•icea Q <br />' 445 R 8:a Ja&lldt 1, P 0 Solt 2000, 9tkn, CA 98201 57- <br /> tHtO AIUDUIIT DUE AMOUNt AIMIttEo CASH <br /> I RI?CENt?D my DATE rEltlttt Ivo <br /> 1! ► ,,.,, �7 <br />