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12/03/2002 15 42 2094683433 FIFTH FLOOR P= -2E 0, <br /> COF'L <br /> •`� WELL PERMIT APPLICATION F RNA SITE <br /> -v1v3 SAN JOAQUIN COUNTY PUBLIC H1:ALTH SE VICES MITIGATION <br /> )A ENVIRONMENTAL HEALTH DIVISION (PHS HD) UNIT IV <br /> 304 E.Weber, Third Floor,Stocktorf, CA., 5202 <br /> (209) 468-3449 <br /> NOta-REFJINDA6LE PERVIrr EXP11aSg I YFAR FROM DATESL] <br /> 'tai 4'o,s hemi. made to Bar Ji '"%n-Count/bra per-t�,to unsuur-+and'ar instal:1,te woes,dcstnbed This W,Itcation is Made Ins comppsrot W,+.h San <br /> ,aegd,n Cnt etty I:s►elepenent title,GF+ap�er9-7 S iv 3 and ih►Stsndarr�4f 5an�aaquIn Carp PON a m mM 5es'vic&s.Ern+lmnrrartal kaarth DkM'Dn <br /> Vr'CLi Lc>at1e3>ti�Yo3 CCDM ck6 Bra-..� Q t ae3se getat s <br /> .rosy sheer_` 4'J�`^3_Qty -� `p - - -ParceN,i <br /> J rROPFP-Y 0%nal 0Scv <br /> C �rAddress 3 3.7- 01ftc-If—..Cio�rar,e-f/-`�,.��f'�as"� <br /> 1:0 w1t:a,ft I Sib w-traarar o"`7�f� �-� AddresCityicgk g?� Phcnc+r E <br /> , <br /> u COD„,alas ;� _ ,Y Tr'—sKm Range' Socber1_ <br /> IWoRy._TOt lPFSirog IES <br /> ELl 1 SGRNZ;(GF r,GeOPRQBE.I.YDROPUNCH,HMD-'.0 GER.CTHER-) 13 DESyRUGT,0N It ncom'c bpa bta�A <br /> [I SOIL SON G# � (1 01.J.RSORE <br /> -!?y 13 m SauRi;G:kou <br /> CA9¢1[Ef+,TS - •• - -- -Cu�sttS,TdPtauars ._ � _ - <br /> I <br /> 'YPE Ca 4N LNSTALLATCtsti}rt E GOt�57t�JC"rtt7lr SPSCi aT S ar <br /> �n�t?I`iT':) ;Nc71 t%HOLLOV1f STr:w OIA OF BOR_-iOLC- k MULTIPLE ri�',S;hi�?13 YES ACNO V'VELL CAS I VG DI;. <br /> 6 ,�+r Ad TION U AIR PAtw%1 C.rMVF-rj CASirvGTH1C'tWIESS—JV,-qV-'r ?e--F C-AING Q STEEL JIPVC }3 OT} Ilk <br /> =OR 11 MUD!R'O-ARY DEC-H OF GR0U1T aEA C 7� I- -rREMEr'PE TO BE USM' n AUGERS KHDI,E <br /> SP a RGE Ep PUSIn PONT GROI T SZ.L PovlpErl AVes a No (NOTE:MAXI AWA FREE-FALL DiEPTH iS 30'p <br /> 100 ;z <br /> 1:10I�ecA'N$ a HAND AUGYR GRCYJT SPEC'=LGATI0MS <br /> D C>'fWS[R. B APPROX BOFING DAN 36 70 J? OLTi:D TRAFFIC DOX o, Q STOVE r-42a <br /> CON 0UCTCk CASE a PROPOSED? Y'Y (11 YES,I,Stspecff=tOns:here) ;1-tS-i� <br /> NOTE: OFFSi E BORINGS REQUIRE ACCESS OR ENCROACHMENT PERR9 T S. <br /> CALL THE THE UNIT rt/INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPECTLONS, <br /> I <br /> I hereby ce;dy that I e pfepared this appllc Tion andthat the Monk will be do. In accordanc6 Vn'16h Sar&30aqu;n <br /> Ctaurdy Ord,na Rure art ulattans,and all appSlt able Cal3orrtm State L <br /> S,gn xTitIerCompwy. ��!/Ltw Ei a f I t y���`'- ✓y°�-. <br /> DEPARTMENT USE ONLY <br /> S:TE MAF'IN UW*,T IV FILE,ADDREV <br /> WORK PLAN BATED: <br /> p,- .cat'an Amepled e F Date,ssued Ar:� 06 <br /> r :.t respaaxor.ey __ L-atq Film tnspmdon By Data <br /> :tet n cto't M604K2tor BY Deit6 ' <br /> vf}i1"Ri cW7�!COir[><fPI�S '' <br /> ACCOUNTING ONLY- ASO � <br /> COOFS F cEE r4FO AMOUNT REMa-r-ED CHECK RE$'D Slf DATE !SRR%nCE REQUASIF# t Iva�c� <br /> C-37„�7_ WGAWAIVE{-_ C-57 Leiter of Autlu,, « Ion to stsrrt pe-nut_ EncroachmentclvC $fCff � <br /> I <br />