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r q1!p S�b <br /> A���-�cA-n0 F0�� SITS `x K r , j <br /> LA <br /> r VVELL P� IT i1TIA'' � h r <br /> T + LT Y�S 5 <br /> y k <br /> SAN.l4AQUIN Coui4TY OUiBLIC HEALTH BERVIGES `p <br /> Al <br /> x .f <br /> ENVIRONMENTAL HEALTbelr,Third l3 QiViSIC)N CPA 9520 . <br /> ed Floor, <br /> 304 E.We 5tacktan, <br /> (209) S.3449 <br /> 4 YEA1�t:R M n �tssuEn de to�cra �e with San <br /> . EfUN4A6tw pERMrr ExPtREB the v�rork de!wibed- This appltCetiCn ES rrte mi Health OMsivn. <br /> NO struet»dlarttssta Pu�tlal•EaafthSet p-MEnvtrunmen <br /> fa's <br /> permit t0 Wn uin County Assess i�s <br /> ypkfraTian ialtereby made to San Joa4On Co"' 4BanjoParC� _ 1 <br /> DeveloprsierstTitle.chepter e- 115.3 ar74 Lite 5mndsrds o! a Cltq G G Zlp� <br /> ,again County S �� Crass <br /> ¢d! N 5 <br /> fnI i.aearten 8 d0 �l C ,"' City <br /> AddtEs9 "13,441 Phone# l - l -d <br /> ROPERn Owner S 5 ZLiCdr- <br /> Z 55 C,Ity b+1Lk aPY�— <br /> dress •0ff li �D Pheae#� -- <br /> nw. ni 6%l,L r Da Cid Bu <br /> ,.57 con4rdttCr I: dress e..e4dan <br /> ;artsultant ISu0 Contractor RanA� <br /> 12 .Y i 2•d r 9,.31 I Gt1 ,Township <br /> ;IS Coordinates:x37057-25-&`., ESTRUCTION lchoese type belaxr <br /> S!OV7^R•90RE <br /> VOR TO BE PERFORFNE GEOPRCBE}IYO�tOpuNGti.HAN <br /> O•AIJGF.R'OVEFV3 R1+SSURE GROUT <br /> NEW WELL I SONNG( SOIL BaRsiaG 4- <br /> WELL f# Grout SperifrcaLians: <br /> •Other: ; .. _ <br /> COMMENTS <br /> CONST-RUGrtON gpt:CtFICATI '"_LMPLt=CA5W�5'�YcS �NO YyELLCASING D1A:_ .� <br /> TYPI?! O�ti�' S7Atl1�'ftON TY{sE STSF-L p PVC 41 niHER: - <br /> KOLLow STEM OIA.OF 6gREHOLE�-- TYPB OF CASING: A HOSE <br /> f1 MONITORING •1 FZcldit=TYPE To Be USED: AUGERS is 3Q' <br /> AER yA,yIM �{(tJR1VEN GAS11aGTHICKN!"55_.�--� �A}C�MLIM FR -�ALL <br /> I]EXTRACTION i3 .F.: ()gip-HOF-GROUT SEAL--I�OfE. <br /> VAPOR �] tJD ROTARY ' <br /> ARGE �s?L15H POINT. GROUT S�r�4LPUN1pEp; Q YAS [� � STOVE PIPE <br /> Q AIR SP GRC7U7SPt:CiFiCATIOAS; [}SOL TED'f�FiC 8qX or � <br /> (1 SOIL BORING B HAIaQ AUGER <br /> APPROX.BORING DEPT H It YES,list speeifica�inns heir}: <br /> 8 C0NOUCT0Ft CASING 13RCPOSEO4 <br /> •COMMENTS: <br /> lllRE ACCESNT FERMI'r <br /> S OR ENCR�]�4CHllEtRi~p NSP oNs. <br /> NOTE: OFFSITE BORINGS REQ <br /> FOR Asti~Renu <br /> CAiI.'t! <br /> HIr UNIT N INSPECTOR a8 WI)RiCI>VG I�IOURS IN ADYANC uin <br /> is 8 I;cation and that the Wore1 State Laws:accordance with San aaq - <br /> I hereby ce+lfy that 1 have preparedulatians,and all applicable Callao <br /> c <br /> es <br /> Rules and Rsg <br /> a <br /> n � n <br /> County Ordir! •telCorttAs Y - <br /> Csu y Tit <br /> .I Date <br /> $Igned x <br /> PrintNansa DEPARTMI"KT USE ONLY <br /> SRI=MA!' IN UNIT lY FILE,ADDRESS: O <br /> WORK PLAN DATED: <br /> sr Date Issued pate 1 <br /> ,lira loft Acaepmd By z"� date 1=,na1 lnsFcc >y BY <br />! 13mul lmecaan By tate <br /> 1305Rut to 1neovdi7%W <br /> COd3reENlS f GOHDTi7Cfi� - <br /> a _ � 1li1fO1GL <br /> L'P•�'�: Alta IIAT$ PEAT 1 SE"ts V1GE FLU: <br /> A=OL"rING ON M C;S <br /> c AeM0 W I ris+ M 3 <br /> PF_vaoas t <br /> 'k <br /> aochmer <br /> Auth z permit` ntrtt docs <br /> C- T� WC__WAIVEp: <br /> C.57 l ex of <br />