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• APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 46 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 388,448 N.SAN JOAQUIN ST.,STOCNTON,CA 98201389 <br /> (209)4883420 <br /> NON REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICeMR1*M In TFIplowl <br /> ANLCATMN IB HEM BY MADE TO THE BµJOAOVIN COUNTY FOR A FIGHT TO CONSTRUCT AMOURS SU FALL THE VIOW DESCRIED.THIS APR1CATMN IB MADE IN COMMANCEE WRN BAN <br /> MARGIN COUNTY DEVEWSMENT T IE.CHAPTER B 1115.3AND <br /> THE <br /> ESSTANDARDS OF SµMATIN COUN71'NANOHEEAALTH\SERVICES.ENVI1gNMENTAT HEALTH DDHOON. <br /> L/M1�BSfµ�:LOyR��ERMUl ARL� Al eJ,�n�.. ] Ly LTiC_.0 'Cl + CRV <Q,I�,FL�LL�J � �� P�AfR�L�E♦L N.AMR <br /> OWHE R'6NAEIE-�1��'FUC/ CIO FINLLLGL C JOC C ADDRF88��3 1M BEEFY Q/I.\.IL ILe.NF�PLIONF I ` <br /> CONTRACTDRillalk 6111 66-M(A'Wl WFAAIr,W AodESe �YBUZ;?v4?LFj LC*V O�+r/ M.NE r,A4./�,,5, &",oz6( <br /> WBCONTRACTUS `D1211( � ANDWSE�/�� L�'•�7�5'�irEl��i{�i 7'!l FHONr'3^'9.4�-9�'eC! <br /> TYFEOFVRS RVMP: ❑NEW W M ❑PFMCEMEM NTLL ❑MONRONHO M. ❑OT- <br /> 0 INSTAMANDIN <br /> HER❑INSTALLATgN ❑HELL SYSTEM PEVAIR ❑CNO...MNECT REPAIR L]VAPoR E%TAND140HYA1 r J <br /> q NSA 13INSr Np. URI NMP BET FT. FIRED WATER LEVM O <br /> RYFf OF MMPI .C� <br /> 11OVTAFBfI1NCE Wfll 13OfoR1YBICAL WELLr ❑ BOIL BONNU S C\ <br /> ❑DESTRUCTION: <br /> INTENDED USF IYPf OF WDI C NS".I'XBPFD CATION* M �1 A <br /> ❑INWRNN ❑OPEN MIROM d A..FWRMIS:2VATON ./ZS ISA.OFC.NGUCl ONCAM . •J4 O <br /> ❑DOMESTIC.E 13 mm PACRREme TYPEOFCASWORR-E MA.OF WELL GAINING <br /> N � O <br /> ❑NBLN:AILRBI 13 DRIVEN DEPTH OF GROW SEAL Z1 BFECIFKADEN R <br /> ❑UAR)ATIOpAO 13 OTHER MOUt REA,INHTALLEO EY GROUT BMNO NAME -' E <br /> lo--OMTONNO GGASM BEN NUPEO:❑V. OHP COMCRETEPEDESTALEYINum:OYAI ONe a <br /> A.G.,DEPTH Zc 1 LOCEINO CHESTER W%RROVE NE a <br /> IROPoe!➢EONeIRUCTI0Ng1EWNO MFENOE:MUD STORMY NR ROTARY—µOFR CABLE OTHER y-- <br /> 1 NNEBY CEIRIFY THAT 1 HAVE PREPARED THIS ARIICATpN AND THAT THE MW WILL OF MINE IN ACCORDANCE WR Sµ.pAWd COUNTY ORIS MNCEB.STATE LAWS.AND ROME AND <br /> SIMULATORS <br /> OF THE SAN MAWIN COUNTY,ROME OMMAM OR LICENSED AGENT'S BMNATUPE CERTIHEB THE MMOWINO:'I CER RY THAT IN THE PERFORMANCE OF THE NOW MR SAK" <br /> THIS PERSUE 18 ISSUED,I MALL NOT EMISOY PERSONS SUBJECT TO WOODMAN 8 COMPENSATION UW80F CALIFORMA'CONTRACTOR A HIRING OR B SCOMMCTINO BpHANRE CENTERS <br /> THE FOLL04WN0: 'I CIRSUEY THAT W THE WRFONAANCf OF THE MISS FOR WHICH THIS PERMIT IS ISSUED.I MALL DARCY IENSONE SUBJECT TO WORWARS COMPENSATION LASS OF <br /> CAUMNIIA.' THE USIVEANT MUST CAM. <br /> .�644 HOUSE IM ADVANCE POR ALL REOMM IN*PW TNXS AT 13M1 Mad1L.COMNEFE DMWINO AT LOWER AREA WOWMO. <br /> HS.x F�fEP�/ THIS One 7/-;�rl� <br /> NDT RAX IdevT eeelel MYe_ - C� <br /> I.RAISES <br /> OF SESTET*OR ROAM UNG E TO ORAND NOR THE RECTORY. A.LOCATION OF NOUBE FEWAOE dBPoSTE SYSTEM OR NpN8f0 <br /> E.CHAIRMAN <br /> THE RCI.TV,AN . DIMENSIONS,..1AI NORTH PROICN. F%PµBpN OF SEWAGEd8PoSA1SYSTEMS. <br /> J.dMENSCMEO OCTANESµO LOCATION OF SUCH <br /> A TRAM AND REpPoBEO E.LN THE OF WEllF WDWN INGFOUDISHPR OF ONE NVNdEO NFTY IT. <br /> SRRVCTVTE,INCLUDING COVERED AREAS BU<N M PATIOS.dEVfWAYB,µO WN%S. ON THE TCPERTY OR ADJOINING RCTIEY. <br /> PAYM EN`! <br /> pc{;�'j,i Tin <br /> J U L 17 1995 <br /> SAN JOArrj,,h �. ""i <br /> ' <br /> - PUBLIC HEALTH SERVICED. <br /> ..ENVIRONMENTAL HEALTH DIVISInN <br /> DFPNRTNEXT USE ONLY <br /> APPllmlen A:al.e BF GN. 7//7/ <br /> Orpul hpcllen By Dne P�mpl.vocrian By ONe <br /> OsrrrvSen Ir�Klbn BY ONs <br /> Camm <br /> ACCOUNTING ONLY: NOr FAC, <br /> TCOOM FST INFO M401MT..T. FIFO ASR RECEIVEDEY DATE In' T/EMIVIS REnVFBT X11MEd INVOICE <br /> w a ass/ 71-7 u <br /> � .,� & ar�l� u Buc �i� 9s6- riS� <br />