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SAN Jn UIN COUNTY PUBLIC HEALTH SERVICES <br /> ON1" ENTAL HEALTH DIVISION <br /> P 0 80X 138, SAN JOAQUIN ST., STOMON, CA 96201 388 <br /> 1209} $88 34Za <br />• 14DN AEFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSl1EO <br /> (Camplate Is ftpml <br /> ncr� cy maac o the San Joaqurr ctinty for a p4rlait to corlstruet and/or install the work desc t•k, aoo, cation is <br /> 0-c"ance Kith San joaquln County D.�elcgnent Title, Chapter 9-1115,3 and the Standards of San .oa n <br /> ces :nv�^ar�nental Health Division _ <br /> CT <br /> �oJ�?ta r ae/cif FareeE�jSr <br /> CItyy <br /> tram /(/1itJ <br /> Address'.Ea x O h — 7�( <br /> 7t' 0 r/ <br /> ac•ot U err zo �tJ .` Address- 9 <br /> / ,f ?dor <br /> f ft.%o <br /> A4dress�d.Al�a' ��� fes 4 Lic# <br />' _Ot VEL JPuHP 1) AE', DELL Cl +ZEaLACE14EHT WELL Il MONITORING WELL # [3 OTHE <br /> . GESTRUCTION Ll UJT OF-SERVICE WELL EJ GEOPHYSICAL WELL A` Ll SOIL )R Ir, <br /> 11 fkSTALLATiON (I Lt`-)-L SYSTEM REPAIR El CROSS-COWMECT REPAIR Il VAPOG (TRACTIC« -L'_ <br /> [� c (I Repair )i P DEPTH PUMP SET_____________FT FIR57 u. _E,,E <br /> Pt OF PUMP� <br /> yDFO USF TYPr OF WELL CDXSTRUCTION SP C F CATIONS <br /> CVSTR'.L '} OP-14 33TTCK DIA OF WELL EXCAVATIOU 0 DIA OF COHOUCTL <br /> ,riESTlC;P2"'r'E (' GRrVE, HACK/SIZE TYPE OF CASIWG/STEEL/PVC DIA OF WELL CA5 _ <br /> _.,'c/+SUR C '?AL T1 DRI"�d DEPTH OF GROUT SEAL SPECIFICATION <br /> G 'OH/„c aT+sta GROUT SEAL INSTALLED BY GROUT BRAND IiAFSc <br /> - H <br /> OR i G GROUT SEAL PUMPED. E1 res (3 No CONCRETE PEDESTAL 5Y OR " ro <br /> 'Gz DEPTk LOCKING CHESTER SOX/STOVE PIPE <br /> rOScD Ca17S'RUCTIONICRILLING YETHOD KU4 RC ZY AIR ROTARY AUGER Ve CA6LEr OTHER J f <br /> macer nuc I nave prepared this apc cation and that the uori wiLL be done In accordance wlth San qac }" _c Creinance5 <br /> _j,rs as-- ;L e� arc Rt-3u(atlons of the s.n Joaquin County. Hoorne owner or licensed agent's slg"rure CZr ar'o-ing " <br /> -na r ')L aLrTormance of the work ror nlch this Permit is issued, I shall not employ persons subject c �GR0WA L71FEIsiTIOh <br /> o, Cali 0;n18 " COntraCtOr'S htrtng or _z)-Gontracting signature certifies the fallowing " 1 cert7Ty naC Ir rcrTcrrronce <br /> _crs- ro nicn nis D- rmit IS ts6ued, I -aLL eirplay persons subject to LIORKMRI S COMPENSATiOH Laws of Ci Or, dPPl1ClYT <br /> CA] 24 riOURS IA ADVANCE FO ALL REQUIRED 111'PECTIONS AT(2031 4BSUZ3, Complete drawing at lower area prov%c-i .,/' <br /> DEPARTI[EIIT USE 91iL7 <br /> ,.aeon .teee.p¢ec 3y Data <br /> l Y/?! 114 <br /> napec on "s _— Date Puop Inspection By <br /> -C. ,on DateCcaments <br /> �QJXTIHc `ONLY AtV# FACii <br /> CODES i EE INFO ,ACUNT REIJITTEO CHEuinCASK RECEIVED BY DATE PERMITISERVICE REQUEST HUW8C9 1xv01C` <br /> a <br />