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Aug-20-99 08: 43A VIRCINF-- , INC . 51b26L�^963 <br /> •... P. Q? <br /> ti <br /> WELL PERMIT APPLICATION FORM UNIT IV <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 4PHSZHD; { <br /> 304 E. Weber, Third Floor, Stockton, CA., 93202 <br /> (208)468-3448 <br /> �pCMt#tar q IreMOr mob#tp man Jba#um C ounry fe s oerr R to car a ar�+d/ar c. thw Fw d ATE 1 <br /> ban Jbfgvrtl County Owaiopme=u Ttrc.C.I%W er�t!73.1 3n0 71+e Snsay l iI RI Sand escr6ed a"jjrc&l:on I&made h cumpierwc w4h <br /> O Qrqurn C"puom Hraatrr Swv"S.Ennronmoruf Hash+dives on <br /> M LiaaNlwn - Cross Spot Se,,,1d 5} a <br /> Aasarisyr c <br /> PROPERTY OwMry"' 5t,AtnyL <br /> d - <br /> ps-sllt C _ <br /> " 'nr 00C47 Cwmaaa <br /> - � rti■ <br /> �a� rJr• Ci �astf 1.�L7Jy��pno„rr�IG ;,tlrV -[`ri.4 <br /> Ccnav1lrlrt�sub Cofl:raciw <br /> t r anaj.3J�{ G� Uc pow f ilr4 S <br /> til9 GoaM�nal#i �. Y <br /> T—3111p <br /> — "- - -Renes ,Secf'o�, <br /> ]�QRK TQ KF pERrOItJII�n --- _-- - <br /> Q NIEW WELL►804mo(CVT.GEOPRORE.myDRO W:H HAN"AJGGGR.OTHER-y <br /> COIL DORRM r . �j - _ 13 Dr6bTRUC710k(d*fte two&below) <br /> v1LL r r/ OVVRnRE <br /> PRESA�I GROUT <br /> COAgIfkrS' - <br /> —...��L M+ar 4 TK77Y TYPE Com= - -- <br /> fl MOWTQRNG fl HMI OW STEM CUL OF BOREHOLE WATIPtA CASINGS?C YES ONO vVEli CASIHQ DIA. _ <br /> D EXTRACTfON Q A!R HAAWFR(MvEN CASING THO(NEQs rYPt OF CAy1NG: Q$TG!<l p pvc p oTNER - <br /> Q YAPpR a MUO ROTARY DEP'f}1 OF GROUT SISALTRrMIE TYPt TO of VSCO; 0 AUGERS +OSE <br /> a AIR SPAR" <br /> sow "Xva r°'"T GROUT SE/►l Pllf/PCO. D Yea 0 Ito (NOTE:MAMM IM FREE-FALL DE"15 301) <br /> Q WMID Atlt3" APPRM.eoRv 4r-DiYTri <br /> 4 ate. p 60+`�T��Ic soot « C STOVE�I� <br /> __.o OTHER_ CONDUCTOR CA$S"C pROPc)4Efr (if YE$.m aPacfficowrI3 RC1!) <br /> C041IM ITS: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS <br /> Ferrer CONY Mw I nave Prr &md thts 2Pp alien and tire!the WOsc WWI be done in a0coldonCA WO Sen Jv00-CO.MV Ordww;Za4•@Wfe Laws.and uses <br /> and Repo awz of riga San JOegWn County. #%.. *wflef Of SCAMOII arrlr6 argnef m oolLAn ore rogwirg."1 ccpory MW hr ow <br /> hr.11Ryr NM prmiJJ It tssrrad ►lhha nor pMlonrxan.�a gran.trork <br /> amplry w N7 Me■arfo t lr M► Ift wcv CC�fpE1MSA1poe taws a�/CaM7bralw.� {pntridoet l'rk�0 of sub- <br /> wFvs<twrg.00A4 r.enols=Ins rvuo f C4I -►�R1�f p1[>•,e prrlwmar�t6 amine naflr Ibf tMMGn rrk Ppf7f11¢is issued.I she$emyoy Person:-4w a► <br /> WORIfFFS'f`OAoOEN$A r?OH L#Mi d GdrRmh." <br /> sgmro - <br /> SEE SITE MA IN UNIT IV WORK PLAN DATED: <br /> tIF7ARTAlEKT U8FKlin,�~�r <br /> App�er0gn AtorPtrd 8r <br /> &orr tnavoctpn by -- <br /> Dar Farr,In=prcftn f pato <br /> Deatfu on tn*pccOMI By Darr <br /> CAYiEa/Ti!CQlfDr7iOMt< <br /> 9"/3 6/407 P�;_" <br /> ACC04XTiKOONLY AAJCW <br /> AE COeEs FIEE Ifew t AMWi pTT� Cxtcac r Kir <br /> CAra PERMIT J 2%WCL REttVasIng T P rfwaaee: <br /> 3 - - --02.02- <br /> U*R I I v-60-F qW lr9n bkpyyAU <br />