Laserfiche WebLink
ram-27—tee 12;1$ PM P.02 <br /> `u-__�kflrs t r 3yEjfi.1 FRt)I i <br /> P. Z <br /> WELL PERMIT APPLICATION FORM UNIT IV <br /> SAN "QUIN COUNTY PUBLIC HEALTH SERVICES <br /> EWRONMENTAL HEALTH GIViS10N (PMS.EHO) <br /> 304 E.Weber,Third F1aor, Slo,;ktort, CA., 65202 <br /> (208) 468.3449 <br /> t&N-A iIDMAwr n PERMti ItA*tF[ES Yl/Jt t!RAY❑ATE ItlAU[0 <br /> :�"•,r,o ...cy+*ok,i'n Sar.•.5a itan Caurryry hr r pt'mlt is Coxal NMWW In • aen . Th»1polculon is mage.r gate 0wry <br /> 'i�r YOM y�il'•-.�i,q,�lv=r'ymreai !A.i Ci-swe.S-1 t 13.3 w lie 7te�larSs Ot Sar JOagVr.Cvun�Y P�v`O,t�k�l4selgr geNtCfl•CnNro�nrr,enbl*01s1c1 Ow�t<a�• <br /> hCt_ t-a:vn �DQ r Sum RLMor City <br /> _cirri prdr' S+�SPnsrt�te ' <br /> 'arouNan�:'.ub Cvr�acwr,�j� <br /> �si5atkh'�-V Adtlr/se I?��e 11a y-0tY �-•�S�S3-.Ah4na>r T <br /> TerW9-" Range_ <br /> irx r 'fir ic�r�`� <br /> IE1u►nrt:t.'SORINO(CPT_.QQ150PflCSi KYDRa NCR HAND-AUGER!,OTt!OM 0 Ohs I to-cTvN fchoose iYfra W'cw <br /> Q!sdtl a lrD e Q OStGR! <br /> PRJ�SSuAS,{tRi?UT <br /> rrr.r.- <br /> ;+T �'ELi <br /> alaTAul ATIGM T►PE r <br /> ._..._m_� t + vfrg N4 vlpt!_t.tOtVG O1A <br /> roOt1.7W sTUM DA Or SORTH069 s vwcTtPt.e e:r�a r+ve 0 p <br /> I:e r •-.-:r!t G AM}gAMkF4$t'DR1ViN CA*P*rwe:Ot"S— p rYrE dR WdIIrtG p S4!EL p P+/C p o-TH6 A <br /> OAW?R (�MUD nOTARY CKM OF GROIFT SQAtr 17, T}tOMIN TYPE TO BE USED: 0 AWC14 O•rpii <br /> D JknR jFM.= #i+4J3t+POINT 6ROtJ1'NIAL IruWgID ID Yes p Na (NOTE:MAXIMUM FREC-FALL DEP7?I IS 30'3 <br /> K*hc APPROX.WRI!O aSrm I7r p @"TIED nwrrO SOX or D 6rQA PIPS <br /> F►k ,_._� __...�}tf't M41l.r�.�_ WKOUCMR CAS lWa PKCPOAE07 (IVES,lilt apocL'catlans trop}: <br /> "4w911EN''.'9 <br /> 60sr E 80RfNGS REQUIRE ACCESS OR ENCROACHMENT PERMITS <br /> .T-jWd or"wi 011rr%ppiwoo 11 mu rm word*41 Do dwm,n aoaad�+a wi►k San Jeagv n OVMb antes. M laNi ani uta <br /> ,u„nr ih.Man Jeaeluiq ae,u�!Y MonreauN+aK or mansed epant a■1govWn COMA-!As+�go,r N:'r east w Met to of pallo�rAw"of(N want <br /> r•.+MaM rra pisNtli!:s ras.e�l RIteM nat errNeY P��auiyect tet i40RK®RS'4�+FlFC�f�rfOM Rewe of C1MN4nr/w" C3erw I�Ore nrlr�of svt�- <br /> COM aaMrO sr;^antN w*a�etre nr,rer,ute,� -+ remy mann the Wf'bn*�of tna work obr rrhdt tNs pM01 It)a.kaasd,r yta!l w4p;dy pereefts 3,4)w,M <br /> tiV�'+k?S ;CA4PAN*A1r0N L of Cadanst <br /> CA FS R q WORKINQ MRffi IN AOVANCZ FOR ALL RE:OUVW0 INSPECTIONS. <br /> ?t;ls^Cert��ry � <br /> =rigt hartrr Dett . _ <br /> 51 337 1N: UN!'1•_-Y 1 *P!_AN': A <br /> - CEPARTUIPff Li39 ORLY + '^ <br /> a/�/lTO Arww <br /> aCc,;�.,,,z.'x'�i"c$Y- --• - Otte �'raallnaperSbn iy ��---�- <br /> ,'•'7.f tr.}p1:nAn Bye' -- - <br /> '+flhuGF�3n tra¢•eGee �� <br /> comma i*s ottwrtest�:___ <br /> i <br /> i .uxnrewrntl0.w AJ00 — <br /> r" <br /> I d'SCCOES , '6L*INFt7 dM{3UN1 11TMITT� IDfHC1IN IIL�C'D 1Y DAT! 'g11ApTf SERVICE rR@QNKJTe IttyUiGe <br /> agoabed •r9 :cl oo-L?-uer r•?dBd EIE gm `- -Dui `6uT19a1. -8 6UTTTTL1❑ 660.10 :A9 Juag <br />