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' 09/17/2004 16 30 2094683433 FIFTH FLOOR PAGE 02 <br /> 09/38/2004 11 05 FAX 8166792304 URS-SACHAUENTO-80 tI;@UUz/UUrt <br /> !j]r2FJ�261'14 lid-��l '?09A6®3433 FIFTH FLOOR PAGE 02 <br /> LL PERMIT APPLICATIC)N FORM SITE <br />' E MIT.IGA-nON <br /> SAN JOAQUIN COUNTY UNIT IV <br /> EWRONMEN'TAL HEALTH DEPARTMENT (F-HU) <br /> 3041=.Weber, Third Floor,at ocktan,CA-, 95202 <br /> (20a)468-3449 <br />' A$l� RA 1 E 1 III <br /> a II'1 gpinprpn�Mq�1$hn <br /> AppGrd�an rt:3liWeCy madsk to San joa4urt ccumy a permit to=mvud ondler Install Ills vtoAcE nret+'+ICell Hleal h Oepo� <br /> ,loaquM County Dc,Tplo RmentTitle,Cha S <br /> 1115 3 and Ina Standards of San-441 cowl gysessot's <br /> ytif9l„[:,LomLlan ZZ✓� S-�r�n���'"C66G�-�� C.�vs�Six � �� <br /> Y ddrosg _ � � <br /> PROPtRTYQwnoe 3 �, �nt, - �tA, =Gv � Alb <br /> p,;y ceM�►dn, F <br /> —T- <br /> GIs <br /> �St'p�a S�UG�tatti+�r. 1f��Pnoltc 6' -^ 2� <br /> Gaa�ufl,�nr�gubCantraceor, �.29�-- - Section_ <br /> IIItes <br />' vIlt ro a t?aFotxN�Eo U oi=s'I�tuG'ndN( �tirPa°slew) <br /> if K O B& BORING C C- OPI�OBr; HYDIZGPUNW-W'.NO-I 1GE�fl M�1 �11ft:ft-80R� <br /> fL RQO •• [y PliEssma Cy r.OVI <br /> n ELLv. <br /> Grout SPeea7Qeon>: <br /> ■Ottrer_ _..�..— w ,l e c la d.�•w �t �� t t s <br /> COM <br /> �TYFit OltL FYTA ON7`{PfeC Cp�al1Ci792 FrG F Tt 'N 7 vas [1 NO y�fi"S LGA£fAI�+CIA_ <br /> n MON1t'GRIN� (}}iOLLdW STEM OGa 0�DORFeHOLt" Fdl1LTIPl€GpSIh1GS 1�'f1"PP dF GAPvC 07kiElx <br /> CPSIr4o-rHICXNES <br /> jl F�`fR4C.1`IOH Q IFC ti+�s+ttAF14117r�VEN PE Tv aE iJ3Ea p QUC+E �Rw HOS <br /> DESPTFl OF C3ftOU'f SEir—___ � 'TFlL'M(ETt►E-rY F sTt 13 <br /> VAPOR 1]MUD ROTARY U No NQS;�AAKIMUM FREE-FAL.L I)F-PTH I's 3' <br /> U A4R SPARGE 11 PUsli POW GROUT$CAL PU&IpEa 0 y_ t <br /> ().&I 90RING 11 WV41)AUGER GROU-r' sPECIFICATION$ s7aVE PIPE AT�'PIZWL BORING Direr El l3OfrT>Efl TRAFFIC 8�S or � <br /> DTIIa 1}YES,III specdiea4orml berg) <br /> CONDt]C'mR CASINGR PR� >a4 <br /> Z'ivn.l <br />' rIaTE: [] FS1TlE �flR1NGS RQUIRE ACCESS OR ENCROACHMP-NT PPERMITS.E <br /> CSL THE UNIT IV 114SPECTolt 4B WORKING rlOuRS IN ADVANcIEFD.R hLi.I.12-Gul in INSPECTJoa. <br /> I twreby certify that I hav*prapared this application and that <br /> a work <br /> klnlawill <br /> Stalro 1..sawbe idong iC acc�ardance Math San Joaquin <br /> County Orr! ait+d lati s,a all applicable <br />' �S � r <br /> Signed <br /> �. <br /> p+not Nome DEPART E USE ONLY w <br />' �J 1_E MAP N uNrr IV I`1LE�AID r <br /> WORK PLAX DATED. <br /> 4 <br /> batr lssu Oata,�..� <br /> pppbcat)din A opted By_ I Mf3pecdon IyY <br /> Gate <br /> 4+r4[l♦`Inspection a <br /> pIIIIuCllan kine6en ey t t e? <br /> clummEm CONDITIONS <br /> RGCRLINTING DNI Y; Allam c8rd � <br /> REC•psY DATE PEFLMrrlSERVIIREQUE5T9 <br />' FRC4t1�S FSE INFO AM0U,ITREMTf Ep cHeCK0, _ <br /> a 1�3 3-7 <br /> t-57 L ell er of Auth-470tlon to 5:19n pertt�tt Enc1-oachmehi do��_ <br /> G 57 WCC_^WAIVER <br />