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12/15/2000 14:36 2084683433 FIFTH FLUUK * ut <br /> WELL PERMIT APPLICATION FORM SITE <br /> ;ITII�MON <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVECES o ILIENVIRONMENTAL HEALTH DIVISION (PN8 EHD) ', , <br /> 304 E. Weber,Third Floor, Stockton, CA., EOZOZ DEC 1 8 2000 <br /> (200)4494�44la <br /> ENVIRONMENT HE <br /> App80211e0 to hereby meds to Sen Joaquin Cour r a pwk to oon*uvt*ndw inion SO work Ge"M e, ma app�'����n <br /> jwuin Coungr Devalopmant TItYs,ChspW 6-1118.3 and dee 8trndards 01'San Joaquin County Public Health Urviees, <br /> 800 W C-6f(y S Cross abet 'S pity S+OCA'A-on jJp� f — <br /> VIRLL Loaagen _ g 9s 2 0 3 aroesM X15. 23 0- 0 y <br /> PROMTY Cdwnar �2wgr k S tiyC0' FES .t6- hea�',t dds+ass 006-W.c k c-1•. S>. .Coy' �o�6-p 5q 203 PhdrtaM <br /> "TOgMreobr f«c;5 u n 5'6-to P 1 i h q e,+dr... 1400 S.50 4 S�. y R;�Irr•onrQ �p94Bo'i � 65(e 30�-Phon sW' <br /> Aansuttant/sub Contractor Addwue CI►y^_�UaM Phanak <br /> alb Comonatns X Y .Township— Rance -_ Ssatlon <br /> aw WELL �,"OPROsf,HYDRQp NCH,MAND4WOER.aTHR�W) Q DESTRUCTION(000"1&"below) <br /> 0 lo To No OVER4M <br /> B WELL p PR!gWRB ORO <br /> GOhIIFsltN1 — ��Orout SpeotA0etl0nat <br /> waiNaT <br /> -- <br /> rMall <br /> Al"Tou TlrJfo <br /> a MONITOPUNG (i HOLLOW SM DIA.OF WlotDK"k, MUI.TIPLa CASINOaa Q Y5S I]NO WELL CASINO 0* — <br /> 8 EXTRACTION p AIR HAbtlu IWMO AN CASINO THICKNE98 "OF CASINO: OSTM LI PVC G OTHEIF <br /> 13 VAPOR a MUD ROTARY DEPTH OF©ROUT$SALE,,,.,__TR/I111E TYPE TO Of u860' 0 AUOM p HDee <br /> a AIR SPARM ,PUSH POINT tIRMY svA6IsUMPsot g Ya D No (NOTE:MAXIMUM 11kn-FALL DLFTFI 13 301 <br /> )r=L BORING p HAND AUGER, dROl1r 810ECIf1s7AMONB•r■, <br /> 0 OTHER: d OTHER_ APPROX.DIwRINO DEPTH n BOLTED TRAFFIC BOX er p$TWA PIPS <br /> CONDUCTOR CASINO PROPOSED?�(sf YES,Ilat apeoll 0b0ft hv*P <br /> scom <br /> NOTE: OFFSITE 130RINOS REQUIRE ACCESS Ole ENCROACHMENT PERMITS. <br /> L THE UNIT N i9vacTow 4i WO KING NOU R IN ADVANU FdR ALL RRON11 tD iNfFE0 ! E. <br /> hereby certify that I hwared this app0clatlon alnd that the work will be done in a000rdsnoe with Son Josqu)n <br /> Qounty O Ina arld Regulations,and all applicable 0@11farnls Etats Laws. / <br /> sw od / ,Sae+ce'..nxsc. P�o� >, M ��I S M�� <br /> rnntNam. ter <- T)-ecK�0-r <br /> DEPWRINT. Dan ON <br /> SITlt MAP IN UNIT N FiLIE,ADvasst: ..,13D(� <br /> WORK PLAN DATED. <br /> ApplUdon Accepted Illy " Issued LEMM4,10 .� 2� <br /> grout kfspeebon By -,oats -s 6 ( r,Pin]Irmpaetlon By Dec <br /> 12F.90W SkyDat. <br /> e011111114INTS I CONDITIONS: I n e =.)- 6-D <br /> AMOUNTING ON{,Y; AIDM <br /> is 000E8 FEZ INFO AJ1AOlM P1519 TaD 0149M 0 W010 BY DATE plow J Si WAU 11"wNff 0 INVOICl4 <br /> t at a <br /> C-57— WC– ,-WAiWIR „�: C-87 Latter of AutheN=gtlon to sign permit:,,,_„Enc:■ ahmant doc,_ 9/27/00 <br />