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WELt_ PERMIT APPLICATION t-JRM UNIT IV
<br /> • SAN JOAQUIN COUNTY PUBLIC HEAL`FH SERVICES
<br /> rENVIRONMENTAL HEALTH DIVISION ("PHS-EHD")
<br /> 304 E Weber Third Flom, Stockton, CA., 95202
<br /> (209) 408-3450
<br /> NON-REFUNDABLE PEFtiJllT EXPIRES 4 YEAR FROM DATE1fiaUED
<br /> Appkca'ion is tit-mo) made to San Joago-n CQ-r•) fp'a p-:,n-it to ccnstn.�.t ardfcr install the wom descrwed Tri,,application s made.n compliance ,vith
<br /> San,Joe;vin CJvv 03ve+opment True,("hapte,y-1 1 15 3 anG the Stmdams of San JQaqusn Countv Pubo c Health serv,Ces En. ronmertal Health Divisio F
<br /> vl1cLL Location-�i i b t"y 0 F F 6 F� i.�Q _ --Crass Stre5, 'ti E h M AN ,,t, MAN`c_�- � Ziff U�R_P3rce+#-_
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<br /> Consol an'1 Sub Cor'-actor F:A rh A Cr E Iz N V-- - -Address_P_Q. 1130)(-BE
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<br /> NELJ'ddELL i BORING, --P7 GEOPPOEE hit DRGPUNCH -,aN0-A-'GZR,OTHF-R'J a DEbTRUC1 ION '&,rose Ii Int ti£lD,r)
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<br /> ,",OMVENTS 3 GI:OP.da $aRtw'r"ys OFF- OF AGRICVaTVAAt. C.0Mrni5510NFP"s SITE
<br /> TYPE CF vVEE_l. CONSTRIJCT;ON TYPE r l_O"!5?r�Cl_;QN SPECIFICkTlONS � ��-
<br /> NITORING C HOLLOW STE'T DIA OF,3CWEHOLF !' I N_ I NO ,rlE,_i
<br /> j f RACT[ON I A,Cti E;,; CASING Tw-rCYNESS._. " -_TYPE OF [l 51EEL FJ - C r OT"Er---N'1
<br /> a JAPOR O MUD-OTARY DEPTH Ow GROUT SEAL-L�'�E LT-TREMIE T YDE TO GE USI=-! aAU:Ci'S 1HOSE
<br /> Fir\SPARGE PUSH POINT GOOUT SEAL PLMPED p"es -� No (NOTE MAXIMUM FREE-FALL. DEPTH IS 30 j
<br /> �]SO.L 6C-,RI,-,IG a HAND Ala.'`.,:-R t,-PROX SORINCZ DEPTH7.5 -�E E T a BCL.TED TRPJ-r 1C '30X cr U STOVE PiPF
<br /> 1 0THEFt r E4P h 0 'v -_�- ------ CQN1DL1GT0R CAS NC PR, POSED? tjO 'If-ES IIS,spwo,f1C9'i-+nS re'?,
<br /> COMMENTS _ S4;OVE OF w�4_FLK. t)ETAILF-V 1f4_ RiktaA�rl; F-KV1Fkrt4MtNTPkL'� WORK PLAN
<br /> P k} VO T U N L I S, 13"-+ --
<br /> NOTE OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS,
<br /> nr reay certify that I rave preDafed tris app Ca..Di,and the t,I@ worle wili bc.e3e a 'n oGLorouoe witn Sar Jaacurn Countv Cil ice, Stare I a-s ars Fo los
<br /> anJ Regxaaons w+the Sari Joa.;ur- Co,.nty aoery a signat+are:er:rties the fo l,avYv,•i '!r,@rt fy fhat+r the f+erfrrrrartce of the�.orrr
<br /> for which thrs per,"it is issued,1 shall not employ person-subject to tVORKPIAN 5 CC7Jv PENSA7',ON Laws of California -
<br /> ;entra-i ng signa•ura cortithes t-e k1lo vir3 i cENrfv mAt'r+fie perfcrma,7ce of Prs vork for ivfuwh tr is om7-rr+s rtstr,0 1 sh-91!e/nplo,'per=t s si ?Prt to
<br /> 14-RiCMAN 3 CCA,'P-w! ;'AT,--ry i_a,, ;at Ca frirrr�r
<br /> r� TELE APP GA-P " 1YS �P-ALL 48 HRS iN ADVANCE FOR ALL REQUIRED INSPECTIC)NS
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<br /> `QnEL h�� �� ' �r..–... __—1•r --_ _�...�..��.�Tlile_^�� .E",�--�''��_—V�_—.--_.7i'�_�11�1 � r���
<br /> SEE SITE MAP IN UNIT IV WORKPLAN DATED_
<br /> DcPJkR'A".=l.T IJSc ONLY _
<br /> Appl,cation A^,CBptBd°J_._.�c..s s,<,�wn1Dale Issues--- i^-� —` -------- aces_. ---
<br /> C'nut InsPe t'on Ev _ ----Date------ __ rmS insr8~on 2-j - -__ _Dste--- - -
<br /> Desructior Inspec ton By
<br /> COtAMEN f$1 CONDITIONS
<br /> � ''CCCLJNTINC ONL r r+lu# FA(,*
<br /> PE CODES FEE INFO I AMOUNT REMITTED CHECK#1CASIJ RECEIVED BY DATE PERMIT/S
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<br /> VICE REQUEST NUMBER INVOICE
<br /> r--7-7,7 -4-
<br /> SR# �' L
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