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APPLICATION FOR WELLlPUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOR-ATTUADASLE?HAM"E7(PIAES 1 YTAA FADAI DATE ISSUED <br /> ICIEgllle III 71*41c tel <br /> APPLICATION 161'TRE EYSA"TO THE BAN JOAOLIIN COl1MTY FOR A KPFATT TO CONEIR1CF ANDI'OR NOTALL TNF VIICW OESCNREO.TWO APPLICATIONN MAGE N C.'OMMfANCE WTTII9 - <br /> -*MO"AOUNACOUNI , ENE 771LE.CHAPTER D-1116.9 AND THE ITANDAR09 OF SAN\JOAOLAN COUNTY MMM HEALTH RRVICEE,ENVIIIDNAENTAL HEALTH CAV".0". <br /> �^ 1 <br /> JOE AA)OIIFIEIDR II <br /> 1ACFL SOMA—, <br /> OWNER■/NADOIFAS Iryp1E C I <br /> COIUCTOR J O ADOIEa , tJt .v vA nloNE`,� V <br /> "COMPACT. ApOREtE CI��TL UCS I..1.• <br /> YRE <br /> fOFY�LIJmm ❑NEW Wm C]FtMACE.MW WELL ❑AAONT opNO WELL/ LJ OTHER_ <br /> ❑NtT TION (3WETEM RE►Ael ❑CfOESCONNECT REPAIR ❑VAPOR OTTRACTIOw WF-U I J <br /> Stkb C'3FM—VM.PS, H.P: _ OEPI H PUMP 1ST—FT. FALIr WATER LEVEL O <br /> ITYPf OF PO1AP7 <br /> ❑OUT#•HERNNICE WELL yIO COI1NIYe1CAtt�WELLA//�� ❑`AH^O�D.�Fa/0o//!NO <br /> �UERRIICTgN: fA � �(Jl �l_ _Y L)�'I_'`. 1�./�l/ IV.J✓. <br /> Nl�ED W T-�T COM T p <br /> TR IO <br /> EMATNS A <br /> ❑NOOSTRAA ❑GFEN BOTTOM qA.OF WELL EXCAVATION OIA.OF CONCKKTOR CASINO D <br /> ❑DOSIESTICRTLNATE ❑GRAVEL FACKMZE,_ TYPE OF CA10q/STEVLAVG DIA.OF WELL CA/IHO 0 <br /> ❑FMLICAALINKIfAL ❑mw,, OFVTH OF GROUT SEAL _ SPECIFICATION A <br /> ❑WANGATYN IAO ❑OTHER OR WT Kft NITAUM BY GROUT BRING NAME f —` <br /> ❑TAow Tomma GROUT wm4pOTmo-Dv.. ON. CONCRETE F"FrAL BY PARLOR:D Y.. DN. s l- <br /> AMwOI.DEPTI lockm CHESTER IOK/ROVE PIR <br /> FROPOEM COISMUCTIONlORKAM4 METHOD:MIA IOTARY AEE-,AFr AUGER__ CAME OIH[R �(1 <br /> I N[RSY CERTIFY T14AT L HAVE PMPARO TIME APPLICATION ANP THAT 7HE WOW VARL N DOME N ACCOIVAH.:E+MRN BAN JOACRAN COUNTY OFOIMANCES.RATE LAWS.ANG MUt AMD <br /> IEGLRATIONS OF THE EMI JOAO/N COUNTY.HONE OWNER OR LKEMEO AOENT"e VONA rum CER11FEt THF FOLLOHSPq;'1 Cf/RIFY THAT worm PEROMIMKE OF THE WORK MR WHIICH <br /> 1140 FfRNP H IMIRp,I SHALL NOT EMPLOY PERSONS VJ"CT TO WORLMCW S COMPWOATIOTI LAWS OF C/J-"R A.'CONT RAC701Ce wFS140 OR tUStONTR,ACTIMO*ONATUIF CERTFFe <br /> TNIAI�q„ f/ GFRISY T=IW THE P[FSOIMPAW OPT WOIK FOw WMICN T ►E1MfT H IeSVFV.I eHMi EMPLOY PERSON SUBJECT TO M'o160YLM'E COMFEYSAIIOM UW1 OF <br /> C A PIE AIU67 7I 1 f1R6>K ASYAMC ►M ALL IElMlel® TIO/1LME,E A,T)ESO FM-fSle.COMRRE OIMLMq AT LOW"Al1F.A EO. <br /> SII YL,. J� TI1. - Ow• (aS <br /> ROT FUN E`- 1.%`N <br /> 1.HAwe of ITIlFTI Mw <br /> OR ROADS NEAREST TO OR IOLRi]MA1 THE FFORPRY. I.LOCATION LN F.OUIE SEWAALE OW104AL SYSTEM OR FROTOMD <br /> 1.LIMLIE OF THE PbPLRTY.o10 DEIENONOM AND NORTH OMCTION. EXPAMSIOH OF SEWAGE DISPOSAL eMtW1. <br /> ).DMeewomwo OUTUW4"AD LOCATION OF ALL EXISENO AND HgfOSEO S.LOCATION OF WELLS NRTNN PAD"OF ONE HUNORID FFTY R. , /t <br /> STINCTIRff%0CLU01H10 COVERED MEAS NICH Ad PAIIOI,DAVEWAYe,AND WALKI. Ow Tlt PIHOFERfY OR ADJOOIMO PIO"JWY, <br /> 6. <br /> 1 Nlell r; <br /> 40 <br /> PAYMENT <br /> RECEIV17 <br /> JUL 10 1998 <br /> SAN JQAOUIN CUUNTt <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISICN <br /> OfFARTMEIT US F Oft T �/7 7 <br /> A.FE.nbn A.e.M.d BT_ w. 1 <br /> 1 <br /> G,wA Irw.n.D.1,sT_, P�.^F ImP..,bn er ^ f111'�x! <br /> ACCGIAITNO owLT: <br /> AID <br /> F FACA <br /> FC CGOEE PEE off AMou%l R@ATTEG CLFcw. SH wcc Mo Ii DATE 11F.1HE1Nc[REOU[S1 IIIMEFrI INVOICE <br /> -711t,118 5QaZjz2 — <br /> Pub '+ee1M S.".-Ern,(O.173(1,97) <br />