Laserfiche WebLink
Sep 09 03 174: 05p" Isla a woOdward 1 -707-374-5677 P- 2 <br /> 09/09/03 TLE 11:19 FAX 91$2900 URS <br /> 06/7.8/2803 0B_02 28946-...i33 FIFTH FLOM - PACE 04 <br /> WALL PERMIT ARpLICATION FORM <br /> Sew joAaum couNTY 03 SEP 1 1 PM 2:V&TIGA71GN <br /> EN'0RONMENTAL HEALTH DEPARTMENT (EHO) UNIT IV <br /> 304 E.Weber,Third F100 r,St=kt6n,CA-, 95202 <br /> (209)468-3449 <br /> R E M PIF alrr E]rPtRE-R R 17 <br /> to construct andtor habil the work described. This aWimbon Is made in compGrrim*th San <br /> %ppYm6on Is horeb7l made to Snn Se�auin County tors t+err+�[i countyErtvvonmeneal HoaNh Depsehrratlr Acac++sOrs <br /> Iaaquln County perafoprts�t Title ChapWr til 41 5,3 tend th <br /> S�r�da,da of 6e+� lwW1^ <br /> At14" `J,T0T 4V. to.�fi✓15i��.��`r <br /> BELLt�ador+l3 ai dam. ix�+rstesX++h uFei,,._+���. .tr+nss street �- <br /> FROPER7YOwner [+ G� Stly tiw,iiiddress 3v3��1• darnF- City Jfi �P ��aaFy'°nelYu q3�-? 9 <br /> ..+� ti l� Addrese�• �0x'3'3G a��• p{y�NVlrh. 7_Ip��.tr��'I13O�-s1 Phene{R_�U�-���`��U6' <br /> CZ7 C0m?,, ,rL•h4 dlww + ;� ?t1D V. c I�wti- <br /> Consultmt/Sub Cnv s-T� <br /> Qrw L. <br /> Add,... 6 w b orsZh ljciF sX f'3o Plxir °iI b 6 - .73 <br /> .Y Township ftnge Secd—.-. <br /> 0715 CoordwYales:X <br /> WO O t2F <br /> WNiEW WELL 113ORING <br /> (CVT.13�COPRQ6E,OvnitoPlfNcii,HAND-AUGER,onfa:t:-1 Q D ever aoa N nw�tTc t�edowl <br /> SELL{/RiNGM lj PFIES-s"RE GROUT <br /> Q m- [TROUT gpECIFICATIONB <br /> COMIUIENTS: <br /> 1+b v, f„n '11 A a <br /> a t=f-tx cr <br /> -ryFZ�OF WEt� 11]st/� M T PEddC11FIG� I 1 <br /> QrMONCIORITIG gaiOL.LOW STEM RIA Of BOREHOLES 1p MULTIPLE CASINOS p LWLTI-LEVEL WFL'L rA5lNr m& <br /> [}6X1 RAGTION !3 AIR HhMMEpJORNIEN CAS1It0 THICKNESS �c k+�TYPE OF CASI;40: Q STEEL XPVC U aTHEK: <br /> 13 VAPOR IU MUD ROTARY DEPTH OF CxROUT SEAL ^ �� r TREMtE TYPE TO BE USED: *AUCEFiS Q HOSE <br /> B AIR SppRGE/aXONE p Push POINT ICP c,CPT)GROUT SEAL PLWPED: , Yes D No (NOTE:MAXIMUM FRIEE-FALL DIEPTH IS 30') <br /> Q SOiL BORING I]ISD AtiAER GROUT SPIECIFICATIOM5 <br /> (]dTHER:��OTHER' APPROX.BORING`D9f i - OLTEF7'CRAFfIG BOX of []STOVE PIM <br /> CONDUCTOR CASING PRopOSMd {d YES.list epcc[fmg1fcns in commml secuo") <br /> GOstmENTS: <br /> NoTr=: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERM <br /> 48 WORKING H(WRS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances,Rules and Regulations all Applicable CaliFOMIS State Laws. <br /> 7 <br /> Sig nerd TitlelCalnDant! - <br /> Wcare -- <br /> print Npi779 DEPART-MENTL.0 E GNLY <br /> 517E MAP IN UNrT N FILE,AD R z S <br /> WORK PLAN DATED: 6- / T C 3 <br /> p3pllrs1lonAeoaptad By <br /> - Geta hued • ree D� . <br /> OroULlnspeatie0By— Ra �� Fina ate <br /> 0e5GtWasion Ins on vy cele <br /> COMMENTS I CC!>Wrilum <br /> ACCOUN,nNG ONLY: AIDE FACT/ <br /> PE CODES FEE NPG WliO4stT R9eTLW3 G}IECfC i PEC'a Dv' DATE pE[iAlal I SERVICE p p{tEST# trtVotCE <br /> S-d 1 � ,n o oo2.t <br /> C-57� WC -WAIVER C-57 Letter of Authorization to Sign permit Encrvochment doc— 9/30/t72 <br /> FIL <br /> E CRY <br />