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_ _ y JOAQU I N LOCAL HEALTH DISTRICT
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<br /> Ptar, '0E!' CELuSli: _ l !:, 11az h.un Ava. , Stucktun, Calat
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<br /> Telvphunu. (249) 466••6981
<br /> -~ APPLICIMON VOR WELL CoNs'1'ktucrioN ott lump Pi:ILhll'1 Permit No.
<br /> THIS PERMIT EXPIRES 1 Y1,AR FROtl DATE MIULD hate _4 .7Y
<br /> (Culapl.ele In '1'rE�p€14,tte•)
<br /> APPlicatton is hereby owdu to the Sall Joaqutp 1,ocal lluarlth mritiict for it ptrutlt to conattuCt
<br /> and/or itiottall the work hurain described. Thlr, app-licuttun 1•; n;icltx if, a:nno1,11au1ee with Sun .1miquln
<br /> County Urdinaace No. 1862 dnd tires Ru'e:H and RugulaaLi„trn of tliv S.ttl Juayuttt I.ut-ul I1c.tlth District.
<br /> JOR ADDRESS/LUCATL(N%nume .+ LL.I1.Q .� �L L._, t:ENSUS ;ttri{.'i
<br /> Owner's Naakr
<br /> Ad d r e s is _ 113 q In f�.e r�Wit 4� _.�..__._,......k. . ...... ..- - � v. � .. . t;l►`' .�d L
<br /> Cuntract or'g Nataa3 Htnn+e+1AKe . r1NJ ffll �t
<br /> 1�Q.' atL
<br /> TYPL OF '.:ORI: (t luck)t NEW WELL AT I)I II-1'1','N /7 PECON111'1'14it1
<br /> PUMP INSTAL1.AVION J —Pump 10.PAIk /
<br /> Utlrer ..__�.�. ...^..... ...,.._. . ... .... ..._ __. _ . -- (4)
<br /> DISTANCE TO N AAkk:S!'t SEPTIC 'DANK ���SL'WL'R l,ltli:ti I'1'1 1'it`iVY r�f//�-� -
<br /> SEWACE DISPOINAL I'IEE.I) t:t S`,V00L/` t''E;1+A':I? 111'1AIX UIHLIt
<br /> PRoPE•:RTY LINEAL}I'kIVATE 19Tmi ;i'1'1t, W1'111 +r: 1'1ZHI.la: lu)htl,ti'I'li'. t:h:t.I.
<br /> INTENDED USE TYPE. OF WELL r _ l,(74 !'Itt,t 11UR; `.1'E c 1 I.,IC,1'1'11U'4
<br /> _ Industrial _ t`.aieole�Cuol I]i.►. ul Ise I l E:xt ate tttt1u _ _jir_. �'
<br /> LDontestic/privuLu _ Drilled Ula. of Well (:a .itlE; _►��,�� ____,., ____.___ , .�
<br /> Uumestic/public UrlvLn Gauge of C,v:1111;
<br /> Irrigation 6174v4.I Puclt 161}tlt of Gr, tit Sual 5CL
<br /> --- C.,thodic 1'rotoctlon _ Hot ary Typo of Crurtt.
<br /> ���ltiyiraval t)thr Gk—j_.t
<br /> tttur Infarurtuw�l
<br /> 1GD�t_d_:a_e__r_.
<br /> tt•tJPlrysiCal SuA r_
<br /> t
<br /> Insl .t11�'cl._�
<br /> PUMP INSTALLATION: Contractor _ A
<br /> -- Typu of Puttipy_ ._____
<br /> I'UMP REPLAMIE?IT: /«/ Star(t W..rk Done _ ...-.__.
<br /> PUMP Wtl '.-,1R: /�� $tato Work Uuna;
<br /> 1)j,STR1UC'I'1ON_OF WELL: We I1 1)1anict ;r
<br /> ' / l Descrtbk: Material.aria! €'rocedu`rt. � /�
<br /> Q1ff Lam'E'�4J �lvt CfJ7 �R ;t.GS �'sl ,1. �.t-}�1J!«_•..f.Gt'I- ?�le'.;�1j�'� L�.1/�_'axf r"at .-��1.1 L '
<br /> I Irer�tby .agree to comply WILlt �� laws anti t�l.aatiun of Ll,e `,"t, I.,.,E;',+„ l.u. rl ib.ulth Diht, :ct
<br /> "t,,E clic State: of Caif t'• rtria pertaining t„ ur rvgula,t wig gull Ui thin Vl1: 'KEq DAYS
<br /> of ter c �;�,pjetion of my work on it new well, I will fua•nt>tt tltc : -11 Jutyuin t.a,c_;t1 11vZ11 t District a
<br /> Wc.LI. D}' :: L1;RS REPORT of the wcl I anti uuti f y t.lte us Lufura: pttt t in,r, tl,i: Wu l 1 its W.0- I!te above
<br /> iniurr.,.,_iun is true to Litt: bust o my knowludgv an•l b,:lief. I 1111.1_ {.:'.' I. .':ri: i:_ts.,f'1 1NSk'Eit"I 'ut.
<br /> Pkl ti: t:ROUTI`G AND 1 FIN'Al. lNiPL
<br /> S ",RI)_ __. -'rtl1' t�
<br /> - ---- -
<br /> (13�,A1d P OT PLAN ON ltl:�'l:It'Sl: _,Il+l:)
<br /> SK f)Ni /� f
<br /> Clltita::_NTS:
<br /> ii.ti,51; S I C120U'C ImsPicTio!, 111lr'e51. til/!� � � I'.t5}'i•_t:TI ON
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