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APPLICATIOF FOR WELLIPUMP PERMIT r <br /> 1 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - - <br /> I ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> IIOMREFUNI)ARLE PERMIT EXPIRE!1 TGR FROM DATE 13SUFU <br /> ' IGRPIn.In T,olk..l.1 - r <br /> 'ARlI[Al <br /> A"'19 <br /> OEM BY MAM TO THE BAN JOAp11N M <br /> COVV FOR A FE MM TO CON.T1111CT ANDg.MBfALL THE YAR(MBCNBMO,TRB ARlKAT..1...M IN COMRIANCE VIII BAN <br /> �JOAMBN COVNN B[VELORAEM MU,CHAP-TEE B-1].1115.8 ANO THE BFANOARVI <br /> OB OF BAN MAON C�OVRTV RRVC HEALTH BEOWE.,ENNNM <br /> IOEMA[HEALTH OMPXIN. <br /> JOe AOOR[B .AMI 2- 6y /U�7c- <br /> OKIIER'. C�. jyA,XI CFTY111 fCPACFL N VARM <br /> NAM 'DBEe. 21[/p6 V JTZ�- `' <br /> npNE E!l 3 5 b�1 1 <br /> cOMaLcreR / L/14/X[.'{ �f1/� �fl✓iA]ry1Mt'11"Wl maea�/y/:fe.'✓ta.L (-f�,_Ix �a? RpN[[ 7h �+ <br /> BIR CIOvrMClO. AOOIE.R it <br /> ,i ,,/ VCI ROME E <br /> TYR Of WELLAIMP ❑N[W Wf[l ❑IpIUC[MFM WR[ x MO,A,omm N'['L• ❑OTHER , <br /> ❑MBrALTAF.. ❑"IL BYBTFM REBAIn ❑GnO.00nNNFCIMPAIn ❑VARIR[XTM[TpNNiLI/_ J <br /> 11N-13 rypK NF. THIN MOP BET�TT. IRBT WATER LEVEL O <br /> (TYR'OF M.m <br /> ❑oVTaFRERNCE WELL Oa[ORrvMUL WEUI p<-B.-THAT B i <br /> OFBTI.1CTbN� <br /> r A <br /> IMTFNOEO VEF TYn OFWELL COMETRVCl10X]PECMCATIPN[' ,( .I A <br /> TR � - <br /> O' INM. AL ❑ORN BOTTOM DIA.OF WELL[XCAVATpH 2JA /OI /dI OIA.OF CONOIICTOR CARINO NA <br /> 0' COMFBIp.N All ❑OMVFL TYR OF CAxITHIHIFI II CH.OFN 11 CABINO <br /> OO O <br /> TV!TA` l At ❑ONVFM ONN O[OrO <br /> EM F[uc<_.:. 'S: <br /> 51=I'kL.rECRxATroN� <br /> I]WVVAI.... ❑EEN[R OROM Bfu nIBf mw BV 01OM eAANH xA.f <br /> p'MVMTORNO OROM eEU IVMRO:❑Y. [ E..0 .fTEI.Tuev ONLLENCIIA OND <br /> ARN�jT,D[Rx -45 .A.CNEn[R.U]mOVE I H, /L 1 <br /> IPObtq<ONEl11VCOON/MIYXO-n NEO:MW ROTARY AIR 1bTAlry AVOERy CART[ OTHER <br /> IINE"My CMTffY THAT 1 1.1 MNIANM TORS <br /> A1RtATpN ANO INAT iNF MAR[WR[eE 00M MACCOR,ANCE KITM BAN AAWIV COVNTV OIOIMANCEB.TAIE UWe.AHp gV1E.ANp <br /> R0111ATpITM NE OF THE ABAOCO1Mry.1roME NANA.O.L F..M ANENT'.R..ATIIIE C[RENI[e THE FYHM\ r'I CERTI THAT M THE RWOIMNOE OF 111,MOER PoRN'1IICN <br /> TON RAR.I....I YIALL NOl[MROV RBeONe eVe.RCT TO WORWAX't COYRNEATpM IAW.OF CAIFOIMA.'COMMC}OR'8 MRIp OR BV.GOMRACTI,w BIONAIVR C[TIIIFe <br /> THE <br /> FOLLOWINOj '1 CENTHN THAT M THE RWOOAANCf OF THE K M FOR 1NRICH TM,RNAR IB RBV[O.I RIALL EMROY FMeONe RVBIECT TO WOROAAM'.BOMFOMAT N.1ANM OF <br /> CAW04NA/- TManA°�'^`ANT MVRTO//A/LL�]JApN�OIgE M ABVAXCI FOR ALL REONR[O IM/BM�CTpXt AT MN1408 F22,COMRFTE OMWINO AT LOVRR ARA RpVX,fO. <br /> .b.a lz l�X.'E(/luC/ FL��. TIIR�I�/y�S-f'" on. 2'/(0•,ci"7 '. <br /> noT ME F KNEE <br /> ;.MHOLe .1 THE AF O.TY. RNEARer TO o.eA1 NOR ENNIMI .. 1. LOCATpN OF lwve[OEwrXO[aBVpeu svrt[M On Ag109E0 <br /> 3.:I OVTLMEOFTMRORRN, ME4NN0 MMFNF Ate MFET"Ax Fvwmb", I� EXIANMON OF TO THOMM BY.TEMe. <br /> ].'pIMEHBONEO OMIME[ANp LOCArbM OF ALL EXRTMO AlA ROIORO " N LOCATb.OF V 11.MRMN MMV.OF OM...H, T, .. <br /> BFRVBTVRR,M tmm coV DARA.BVC H AR PAl...ORVFVIAYR,AAO WAIRB. OM THE.11 CNI <br /> AObOR,NI RORRry. , <br /> 11J• ^ (�r ��C. k O Gyp E lle <br /> BnMTMFNT w[Bnlr .. <br /> Ap111anbn A...IIr er 6�A/DI h : 'II BDY. _M. . <br /> a.,RA lrw..Ix.er I,I�.IAAA r-Inn - rte' IL y <br /> B.I 99 R...I I.yYILR er ENN <br /> L(a-L^Y�Cclu�-µl-[.Q�j 11`6-19 9 <br /> O.I. . ._._ <br /> ICCOVNTMO OMTI ANI <br /> RI M. FEE I.. AMOVNT MNNTTM CIMCIRA.N ...MO.1 OAY! RRMTNBH E.RFOV[tT M1Ml91 INVOKE <br /> _ I I <br />