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01-16-1996 04;24PM FROM. TO 15103130302 P.02 <br /> sa 9XVf1{OMMENTA1 HIALYN b111010M from,. <br /> codDep.1. ' .�. P OX 300, 045 N.4ANt,JOAQUIN 9T, VOWON,Ck'48101_4 <br /> PhOn4 <br /> Fall pfl(wB ill PLpMIT 13FI 11!_Y tR FAdllh �itfUW <br /> %TrIONdetef. Vq: <br /> Apptieatten ie her+' by mod& to this San Joaquin Comty for a petal to Consceuat'�nSd/ar Install th4 work daseribad. This applfoattaa {: <br /> club in wptience!kith Son Joaquin County Devalopmant Tlttwj, Chaptr,'P-�{1� I!nef�he Standards of San Janwin County Aubtie Heatt! <br /> 86rvfaea, &Nfrorm4htst Heateb Division. _ P. r "t <br /> Job Addr6all/or APHN 23401' S. Chrisman Rd. city Tracy SixaJAPu#_, tree <br /> Addreaop Q' 80R Z Route 10 W. / <br /> Owns to Suburban_ P_r__yane Affil an Phone al 887--530( <br /> . iyr. PSI Addreaa2280 Hates Ave. Concpid,tsA* — phoa.W10/6$ -2481 <br /> _1111116contioetor Gregg DrilUug ,& Zs n Address 950 Hoare Rd, Martinez, 00 48 165 phone 10/313-580( <br /> TYPE-l)�tR[L�� i NEW WELL 0 REPLACENENT WELL MDHITORING WELL t3 OTHER <br /> (1 DESTRUCTION IJ OUT•01 10VICE WELL 11 GEOPHYSICAL WELL 0 (X SOIL BERING _SS 4 <br /> 0 INSTALLATION (I MLL SYSTER REPAIR ti Q1002+-CONNECT REPAI2 t1 VAPOR EXTRACTION WLtL <br /> i <br /> i 0 Nasi (I Repsfr N.P. _ DEPTH NMP ICT FT. FIRST WATER LEVEL�_� <br /> (TYPE DF't�lliP�'"—j <br /> YYPE.A WILL MRSTRUCTiON BP CIFICAT D S <br /> Q INOU16RIAL tJ OFE'N-BOTYCA DTA. OF WELL EXCAVATIQII. 8n p1A. If =M CTOR CASING_; <br /> I1 00N42TICJP'RIVAT# N GRAVE{. PACK/4111 f12Q TYPE OF CASINWITELL - - DIA. 6 WILL CA911110 2" <br /> q PUOtIQ/iK1NtCIPAt i1 DRIVEN OEP1H OF cROUf SEAT. ^' 1-3—feety sPEctitcATtoNO.010" Slot <br /> 0 IRRIGATION/AG tJ OTHfIt GROUT SEA!, INSTALLED BY Tagg rM1�n46roUT•)SRANO NAME cement <br /> 33 MONITORING +� GRoUt SEAL PUMPED& t) Yes VI No CCNCRiTE PEDESTAL OY ORtLLER%XK To* tI N <br /> APPROX.01PTif 20i Ng__ LOCKINO CHESTER BOX/STOVE Fire, traffic gt•A.6_ christy box <br /> ROFGSE�Ciatt$TG11rirbltlDNiLIJX6 <br /> IfUH GO. IUD WART.,_AIR ROTARY_,,,,. AUGER 2L CASLE_OTNER--i <br /> I haraby.cert fy thF►t 1 hava;prepered this app ication errs that the work vitt be done in acwrdanct it th Ben JoAcot naunty Ordfnah000 <br /> State Laos, and Ruties and IiiktatlOft of the San Joaqufn County. Boma owtar or ticansad agent's itanatura eartifies the following- a <br /> Oartffy that in thalpyrfor"ance of the work for which this permit is issued, t shatt notlay parsons subject to-WORKKANt8 COMPERSATl0 <br /> Laga of C:Alifornia0 Contractor+t W04 or sub-sontractinti signature csrtifias tha f towing: -fie I certify that in the performano <br /> of the work for which this patlaft It iertled, I shatt.NP(oY p+irsrrtn object to wol01AN'S CCNPENSAtj(yN Lawn of California." THEAPPUCAU <br /> MkUUST CALL 14 B A YAOCR pb ALL A 11110 MP=#AT I7. dto df a"Irto 4t take. areq pravfded. <br /> Cal 17 <br /> sued K• ttl a pec a st Data � <br /> PLOT PLAN (Draw to scats) softie:_* to <br /> 1. Nsata of atraets or toads nearpo <br /> est to or bouMine the prorty. 4. Location o house sewaya disposal system or <br /> 2. Out[,no of thel roperty, fvfno dtmehatons and North direr=Ion. proposal olc�ansfon of sewftle dt yateha. <br /> 3. bi pp ff npReal a <br /> e!a}tsfo&ted oet�lltle0 and oeetfol► of all existing erxi proposal 5. Lacbtlen a. s&a{la uithtri radius of 150 ft. oh <br /> strVCturea, tnitudin8 covered cess •trail sa patios, driveways, the prapartl or ddjoininS property, <br /> and i&Lka. ? i <br /> I <br /> I <br /> 01PAR[MINt 001 Duty <br /> I <br /> Apptic.Cion Aataptdd sy <br /> q <br /> Grout InOpeation a I 6 l pus# Inspection sy Pat#_ <br /> Destruction Inspect ion 8y Date_,,,_,_ CaRtnmts: <br /> I , <br /> E <br /> ACCO{J1fYitt6 GRLY: 1110 FACE <br /> 09 CGDE! SEE 1 0 Atdalnn BEttMID CONKPICARN R1GMM BY DATE P111111711mme E NEOU42T UUMER 1ttVptpE <br /> —Al 06 <br /> i <br /> TOTAL P.02 <br />