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San Joaquin County <br /> Enviroemeet2l Health Department �(�/c SITE <br /> 600 E.Main Sbwt Stockton,CA 95202-3029 ION <br /> T <br /> ' (209)468-3449 Frac(209)468-3433 Web:wwwsjgov.oWeHd:�( > UNIT n/ <br /> o WeN Pef mlit Application <br /> NO*41EF NDMLE FMW EXPIRM 1 YEAR FROM 0111E aisU® � p�� <br /> AppGrAm Is treieby node to San*mgtm Coady fm a pm d b con$*W andMr xwW to wuh domatod. This aPPaemtun ia�Ja,e in mn*f nth San <br /> Josqun Camdy Deme WMM Tile.Chepw 9-11153 and to&wWmda of Sen Jaepi n Coady Enrnaivoobl Heamh beprmntliL <br /> WELL Lmdm 13731 N.Id�tlu,y aS swam seeel <br /> Oasrs Ona/Y/lS nearesa (373_ 1 N .X88�y t-o�: zw`tDf.�es2�'�G7-1910 <br /> c-aT cam �$T 11r I)i� Aed Asa"�N,G-as E St caale��.�Zv S�XtI reef <br /> Camdt"I S6 Cr6 Addm City Lics Phnd <br /> Gs Commmobr x Y Towlnh p Renge Sedan <br /> MMMTOBEF� <br /> iEW WELLI BORING .HYDROPUNCH,HANDAU ER.Dnl� D DESTRucnom pfa w type bda.4 <br /> JJXW SOIUiGi 1 aOVER-BORF. DUMEYFR <br /> B v4U L 4 p PRESSURE GROUT <br /> 0 mew GROUT SPECRICATTONS <br /> COK MFNTS: <br /> TYPEOFaiEu MWAUAMONTYPE 9mmicromspEcumAROM <br /> f]NONTORNG D HDtuOw STEM aA of OGREHDLfa_E 0 NLATIPLE CAmmaas D YIILTw EvEL wEu cAsNG DIA:_ <br /> a EXTRACUON s AR HAIMERURM34 CASING THICKNESS TYPE OF CASY/(? 9 STEFi D PVC D OTTER: <br /> 0 VAPOR u NLfD ROTARY DEPTH OF GROAT SEAL--+D Rkw- TREpm TYPE TO eE t/sf'O: Q moaERs xtcw <br /> D AIT SPARGE1 tiza€ YpusH Pawn IGF or CPT)GRDUT SEAL Puupm p Yea ),No (NOTE:YAM MIN FREE-FALL DEPTH IS 30') <br /> u SOIL•8ORNG 8 HAND AUGER GROUT SPEC FICATIONS <br /> Q OTHER n OTHER APPRCX sORSNG DEFM e 0 BOLTM TRMM still w Q STOVE PIPE <br /> CONDUCTOR CASNCPROPOSE (t YM,igspedfotbm inmw smaim) <br /> C01003m: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE RECIIARED FOR INSPECTIONS. <br /> I hataby cwdry ilial I haw pripand lift appludon and dig dw wok YM be char In acaotdmm wIW San JoNgrM <br /> County lrncos, andand a0 app/c"Cal§ nla 9tob Lawn. c� <br /> x 1 Tad(m.p.q✓.Pneo4 Q'!1 ��S <br /> Pdd N. Jc Orale' v T J <br /> DEPARTMENT USE ONLY <br /> SITE MAP NUNIT N FLL ADURM& ( 7 pN• 11-20 <br /> WORK PLAN DATEM <br /> ApprrMm ' Dretwri ?f�7(n� Ama t'4, <br /> Gmd lnmpea" ay Ode T=ad inpmdlm By Dow <br /> Derauwn 9y OWA <br /> cca=3 /COItOp10Na: ' f r 111, n r;.. " .Nn^'Ul.i - LA <br /> ACCOIANTNG ONLY. AIM FACX <br /> PE CODS <br /> fix a" Aa1Glartt8T7FD QNOCi RECD 6Y DATE P9NaT/Sa91aIM�N6lEST� NIOICE <br /> a fob tY5 3l( N(� �/2.707 Slim <br /> C-57 WC -WAIVE G57 LMw of Autha'fmtan to SW perwlf Ena'o WWWt dae <br /> EHD2%4Z4Nwlt <br /> 6r.vZA t <br />