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ry APPLICATION FOR VVEWPUMP PERMIT �, <br /> SAN JOAOUIN COUNIY PUBLIC HEALTH SERVICES j` <br /> ENVIRONMENTAL HEALTH DIVISION _Q81 <br /> P.O.BOX 380,304 EAST WmER AVENUE,STOCKTON,CA 95201388 D D h O <br /> ;2119 46e-3420 <br /> to <br /> NON_AEFIINDAbIE PfARfll i%PIRf3 1_pEI1A FROM BATE ISSUED paZq <br /> (C�rnbu M T,e7icot.) -- <br /> AMICATION IS MY MADE TO THE SA14 JDA(It)IN COIJNI Y-On A I*-11 Tn CO/iRwRl/f.I AND,4m INC.TAI L THF WORK UESC.NMEU.THIS AANICAYMN 18 MADE IN COMPL:.WCE VMN SAN <br /> JOAOIRN COUNTY DEVELOPMENT TRILF,CHAPTER 9-1 115.3 AND III[STANDARDS OF FAN JOAOUIN COl114"V mistIC IIFAI TII 9fn"CE6.ENVIRONMENTAL HFALTN Mvtm <br /> JOS ADORE 69M F:AM. 67 <br /> / ^1 4- ^ .. C•I y �— _PARC.FL BIZEJAW/_ L=' <br /> OVVPIFR'A NAME - IlOwsm_ Q�Q1 <br /> E�1 el RHONE <br /> COM/NCTOR I��1 / Q_.. ._�._....._. ._ADORE:+F__o E7+q()rtJ_� RIONEILL/ <br /> OUR CONFRACTOR V^i _AUOFL9S_ <br /> TYP[OF WELLNUMp: jdt FW WELL RFPtACFMrNT WETL L.l 1.1nNROnw-i Iw I,# ❑OTHFR <br /> Cl INATA:LATIONU WEL 9YBTFM RFPAIR U CTO96-CONNF TFIFPAIn ❑VAPOR FIITMCTION WELL FL_..�. J <br /> N^u❑IyP.h N,P.�, Of-I PUMP CfTy J T, FIRST WATFR LVAL <br /> CTYPE Of R1MPI <br /> Cl OUT-Of;vnvwF Wfl1. ❑GFIIFniv;ICN WEIL!_ ❑ Sam SOnI11O__ B <br /> ❑bESt MICT1ON <br /> INTENDED Ui! TYPE OF WE -- Pg.-ATgM UON dPECIFICA11UNA <br /> ❑ NAL "AL ❑OPFFJ BOTTOM OVA.OF WFII F%CAVAIION_` _ DIA DF CONOVCIOA CA91NO U <br /> 113OOMKBIR;/fTIVATC 1L�rlJ RRAVEL PACklF12E -,._,. TIM OF CAS.w.'n IF 11'r ; DIA.OF WELL CASNO F D <br /> U PURUC?MINICIPAE UF--11 OMVTN UUTII OF VMNIT RFA' <br /> __ r— BS4CI/ICAT IDN p <br /> ❑IRPNi AIgNIAO LJ OTHER f:BOUT SF AI.1N 6T AllfODDppBV_ TT� ` OROLR BRAND NAME F <br /> ❑MONItOTRNO / OROUT$F AL vim,D:MYw QNn CONCRETE f�E PEDESTAL SY DRILLER,101 Y. ❑N. S <br /> APPRDk DFTTH�- /7a In IA IND C f IF.1 En DO.19T OVE PIFs____ S <br /> PRO PO.ISO CONI TRIM UO NIM LU NO M ET HOO: MULF 00TARY` i(. AIR SOI A'1- AUGER_ CABLE OTHFR <br /> I HFSERY CERTIFY TI IAT I IIAVE PFFIARED YHIS APPLICATION ANnn YH`ATT IHE VA M WILL RF TINE IN AC C OMAWE WITH RAN JOAOUTN COUNT V 0MDINANCF S.IYATF I-AWS,AND PULER AND <br /> REGULATION`OF THE SAN JOAOURL1 COUNTY.HOME OVVNUI On MCNSTn AOENT'8$IONAI UnE CERfIFIFB THF FOI LOWING:'1 CETT IFY THAT 1N THE PERFORMANCE Of TIB:WON(FOR VYWH <br /> T/NB PERMIT N IRSIIFD,1 SHOE NOf(MPI.OY p(nADNB BURJFC7 TO WG RSMAN't COMPEN.ATION 1 AlY$Uf'CAUf Ot►UA:CONTRACTCR'9 MNNO OR BUS-CONTRACTING SIGNATURE CERTIFIES <br /> TI R<FOUOWING• '1 CERTIFY IHAT RI THF PFRFORM ANCf OF Tim WOT.•FOR WHICH THIS PERMIT IS tRSl1Fn.1 ANALL EMPLOY P(R.ONW SURJFCT TO WORIGAAN'S CDMPIEN.ATION IAYv.M <br /> CAL90MIA.- TM PP'LICAN MW ff C/Aµy,�N HOURII 1N ADVANCE PLR ALL RJOARFO I/N�i/TPFCTbMd AI t"#t ASN O.Ef.COMlT FIE ORANSNO AT IOWfR AREA F'110 VS)E , <br /> `IIII Blv. k �'JlJ 1f1'�dH.f'L _.TIII.— <br /> PLOT►LAN In—I. <br /> ".-I f:F.:w <br /> 1.NAMES OF BTREFTS OR ROADS NFARFST TO On DOUNUINO Tllf.A701'F.RTY. I. LOCATION OF NOL)FIF RFWAOE DISPOSAL.y9TFM OR FYIOIoa(D �7 <br /> Z.OUTLINE OF THF MiOPFATV,OIVNp DIM[N6ION8 AND NORTH OInEC I AIN. - '-_ -- FRPANMON Of WEWAOE DISPO.AL■YSTEMS. t <br /> ].OWFFIS OIED Otntmr.Awn I.00AmN OF ALL ExivItNO ANI)MOM9FO d.LOGATMN OF VVFIl.WTTHIN RAOR15 OF ONE HUNOREO FIFTY FT. h� <br /> STRUCTURES.NCLUOINO COVERED AREAS SUCH AS PATIOS,UIMVEWAYS.AND WAU'F ON THE PROPERIY OR AOJORNNO FSIOTA'RTY. V <br /> ` � PAYpAEN� i° <br /> i 4V <br /> �1997 <br /> �j v � DIN JCAO'J1N 1S£m'C7:8 <br /> C.� � ELIC V+1:ALTN <br /> J +��u.I� FNV1 pNMcNTAt HFALTNDiV{Sl0{•� <br /> I <br /> O/fM1MF,NT U.E ONLY <br /> ApPll..lbn Aaewved Py rP-( �r_�� __ O —11 674Z MN <br /> O,—I.wP,rllen <br /> ADCDUNTING JHLY: I AID# y I DAL/ <br /> PF CODER FET.IN10-1 AMOUNT RUM IEn .1JFC%F AEN AEC^VED RY DATE PeFIfITAMINeF Rf OUE1/NUMB INVOICE <br /> Pub Heahh Sere,-Enywo.M(3196) <br />