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APPLICATION FOR WELUPUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 468-3420 <br />WON-REFUNDAILE PERMIT E%PINES 1 YEAR FROM DATE ISSUED <br />ICemPMte M TrpNealel <br />APPLICATION I6IEPL BY MAbf r0 THE SAN JaAOINN COUNTY FOR A P[rMAlt TT7o��CONeTR1ICT P-mmm MSrm THE WOn( D.ncFv En, TING APPLICAMN la MADE IN COMRLWCE NRTH SAN <br />JOAOLNN COUNrY OEVELORPAEJNTT TFTM CHAITERx9-1116. 7HE 6(A clfLg/rpMAGUIN COU P SUC HEALTH MIMES, ENWIONWHTAL HEALTH OMMON. <br />JOB AODFEISron APN# r[ / L- ' ay -v_`'CITY P EL GIZFiAPH. <br />OWNER'N NAME _ AINHtfSS PIMA I y/ <br />CONraACtn _ AOOSe I/C� RgNE I�U <br />BUB COMRACTOR �- REAOOIEq # PHONE <br />_TYPE O! WELUWT-T <br />►Nn �.l NEw WELL ❑ WM ACTMENT WELL 0 mown NO WELL or ❑ OTHER <br />❑ RINTAMATION ❑ WEIL SYSTEM rFPAIR ❑ CROSe-CONNECT IMPAIR ❑ VAPOR EXTRACTION WELL / J 1 <br />HYPE OF PVM/7 <br />❑Nt«F❑R..W H.P, DEPTH FuNip SET 1T. MST WATER SEMI <br />Lyy--1V-\-* <br />/ ❑ OUT OFIERME WELL ❑ oEopllYa AI WELL E 0 som aaIN11a S <br />BTMILIION: _ <br />(ENDED WB YPSO CONN 1 7WELLION TIONS y <br />❑ INUUNTMAt. ❑OPEN BOTYOM 010. OF EXCAVATION _ n1A. OF CONOUC ton C AMNO D <br />❑ UOMEaT nmv#LTE ❑ OPAVFL PACI(MgE TYPE OF CAWNOMTEEIJPVC OSA- OF WELL CASINO D <br />❑ PUBL/C/AMINICWAL 1❑ytNNVEN DEPTH OF GROUT BFALsPECIFICATIoN H \ I <br />13 SIWOATIONFAO CJOTTER GROUT OFAL INSTALILD BY DHOUT MILANO NAME F <br />Q MONNONINa OROVT REAL PUMPED: ❑ Y- ❑ Nn CONCalTE PEDESTAL BY DIULLEFL-D Yw ❑N. d 1--� <br />ArPROX. 9171H LOCKING CN(ST(R SOX)STOVE PIPE V+[V <br />PIIOPOSEO CORITRIIO TIONMWUNG MEtNOD: MUD ROtANY_ ANI RUTARL' _ AUGER CABLE OTHER nl <br />I N(VOY "ITTIFY THAT E HAVE PWAFED TINS APPLICATION AND THAT TNT WORE WILL BE DONE M ACCOPbAHC1 iAntM IAN JOAt71AN COUNTY OMMAHCEB. STATE LAWS, AND RULES ANO .5 <br />WoLAATIGNN OF THE SAM JOAOUM COVMV. HOME OVWRR OR LICENNNO AOENT'e 91ONATINE CEMIFIEB THE FOUOWOM! '1 CMWY THAT SI THE rFMVfWAANCE OF THE WOW ron YMSCII <br />T INS PEFN.ET IS INe11ED, I WALL NOT fAMLOY PE B41eJECT TD W011NINANY COMrdSARON LANA OF CALNOISNA.' COMFNCTOR'e /1W/q OR sI1BtOHTMLTSlO sIONATLNE CEMN'IEN _y.... <br />TIE FOUDYNNG: ' I CERr1rY THAT STI TIE RMANC! OF TIE WOPK FON WHICH T/SI P'EIVATT IS 1NSUED. 1 NULL EMPLOY IiRSONS NUL ECT TO MOOVA/W'N CaMFdIAfroN LAWN OF 1 <br />t:/WFOIOIIA.' 7 CANT TCA AOtA/ICe FOR ALL 11EM1N1ED T11TNs A 170NT IgOAlT. GO.APLM OFIAV UIG AT LOWER <br />Ptor 1D1... ti Baal Se.I. - ro <br />1. NAAIlB OF eTIEEETe OR ROADS NEAIIEOT TO on eomminO TIE T11o14MY. I- LOCATION OF NoUBE NEWAOE Of$eAL eYNTEM aR pFX"GFO . <br />!. OUTLINE OF 711E "WPEFITY. OHIIIM OW"IeIONB AND NOKM OIREGTION, EXPANSION OF SIWAOF. DWVOAL NL•STEMN. <br />O. OIMENSNINED OUTLINES AND LOCATION OP ALL EXWMG ANO PrIoPOSEO S. LOCATION OF WELLS WINCH( ILAOMO OF ONE HIINDIEO FETY FT. <br />ST WTUREB, SN;LVOINO COVMW ATEAS BUCII AS PATIOS, ONVEWAYS, AND WALKS. ON THE MIOPFRTY OR ADJOMBILI PROPERTY. <br />. �.... i. .�...; i.i i <br />I <br />AnpftwIt Mmgtal <br />ll,mA Mnp.�1NtI ey <br />Ihnl.wNon AwnaofFp <br />ACCOUNTING ONLY; I ASO# <br />PE CODES I FFEINTO I AALOVNTPtVMtIM <br />USe ONLY <br />q.np Irxn.albn <br />FAC# <br />AIII__..I RECEIVED BY I DATE I P9I4 VIETIVICE HFULMOT WMASM <br />/59Lj5• <br />INvol[e <br />