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12/03/2002 15 42 2094683433 FIFTH FLOOR PAGE 02 <br /> WELL PERMIT APPLICATION FC RM SITE <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SE VICES UNIT IV <br /> ENVIRONMENTAL HEALTH DIVISION (PHS HD) <br /> 304 E.Weber, Third Floor, Stockton, CA-, 05202 / ���G —� <br /> (209) 468-3449 L�j� <br /> rzN] LE P1=RMfr EXPIRES Y-FAR F DRit BATF- fr � <br /> ,zt_p�s�h;n tat l,erelsy made to 5sr�aaou,:Counr�to a pet"rtl:tQ ct+r+s�ttr andlcr instep tie xCrk descrtbed Tt�awl rcatron�.s made in axmfi�-sc�v7lt•�liar, <br /> jaq J't Gqurtty d&;eloprnent Title,srtmpter g-t s 1s 3 and the StEmft t of Son.:aaqu;n Cauny Pink health Ser m*t Fxmronmemml i-easrh Drfl ion <br /> WELL,.v=ftri_!_"'I j � - _;xose Street city CIry P _Pareer,� <br /> FROPEI" y owner_ T_--moms �C.��f6C. GI!y rt ��� �Phor��➢"-���'_� <br /> 5" c nt-dctor f'r�ajt Adt3retc^[.c7�' E w►a�,�!1 - Clty� �honr: <br /> - r <br /> o isuEzant I Sub C=amwor 6:0tw^ Addie 3� ti! Clty �Llr Pham <br /> IS coo d'-at" X- —'y Township� Ran�e� $6Ct cr, <br /> Y1 1ECY TQP-PERF D <br /> Eo"u`.1£L1.I 80F;:NG GEGPAOBE.HYDROPUNCA,HAND-AUGER.OTHEFM 17 DESrRIJMOt4{choose type bels! <br /> U WtL BUFRU I I3 ^�V�„BORlr <br /> r �,r •-�— ���e,t�ra:rans• I <br /> .'rpg PF naLL f#ST&LA 2 1 E CQNUSJmQb SPECImATIgN i <br /> Ix F.SS:M-DRING Q-i'OLLOW STEN OIA rF SlLFElL€ ML1,.TIPI.£C9MSjN 4 p Yl=S P(NO 1,Vtt.L CASIN,3 DIA _-- <br /> a E ,TPACTI m U AIR HAlv1W V-"%JSN CASING THICKNESS TYPE OF C.5 ING Q STEM 12 PVC p OTHER_ <br /> fti,F'OR p N UD RD-ARY DEPTH OF GkOUT 3EAL TREta r=TYPE TO BE US£O I7 A-JG Ra t�,JOSE <br /> LJ1 .;1ARGE )(PUS,Pow GRoL'TSEALPu'jp£D jtyes 0 Ha NOTE: MAXIMUM FREE-FALL CwE�:'L O ]W 3o I <br /> L SO-(34F'i:NG � E PIANO AUGSR GRt'ri,IT SPEC f;CAMNS <br /> F°IlrE2. �t"U O'E SEP � APPROX BORING REEVE OLTzO TFZAFFiC SOX ar 1]5TOVS PiP- <br /> CONLUC CTR CASIN 3 PRC��-16�{lYF.S,IEgt E;pet.sf' mtoms item; <br /> "COMs1`Wi�tTS- <br /> NOTE: OFFSITE BORIINGS REQUIRE ACCESS OR ENCROACHMENT PERLMI i S� W <br /> CALL THE UN6T rV INSPECTOR 40 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INST)F-C1 ONZ; <br /> I nereby certify t at I have proparW this gip prcatEon and that the Erol*will be do. e In accordance vote San Joaqu,n <br /> County Ord3 Rules a Rc-gulabons,and all applicable Callf"niat Stats L ms's. �0&4- <br /> Slgn&d x Ts;ItFCompany 4� - Re'"°�a.�.,.• <br /> D/ NI � _�..._ <br /> '1/LC /� //EeARTEMT USE 0�,LY <br /> 1�1113E fiAA IN I.tIV:T IV'FILE,ADDElaS: / t/�� � <br /> WO RH PLAN DEWED: — 46-Zlo <br /> s �llcYion� dB ,_ spate1vWg4I12,_31-per <br /> � r.a.'1n spt:G�zyti Ey _, Date Frna'inspecdo^$l' <br /> � �— <br /> E�Iruz;,I on lniUomwC Dat$ - •--..-__ <br /> E <br /> AGCC UNTING, iLY- A00 <br /> } <br /> £CODES PHE INFO I ^MOUhT RElr111 I%; CHECK$ FIE 'D 9Y DATE RNIrr r SERVICE RE-QUIET i 1�tfblc£ <br /> =��:� � 2r• moi. t'�� 032,1 � � <br /> ��������' <br /> - <br /> -17--j(— WC -WATb':'i2,�,,, C-57 Letter aT Aut6x-tac�-ton to sign pertnr# Eruxoae 'dhent doh_ <br />