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,V <br /> SAN JOAQUIN COUNTY JUN 1 9 z�►i4 <br /> �.• fo <br /> -, ENVIRONMENTAL HEALTH DEPART ��� �" LOP <br /> & NMEIV1'ALHEAtE MITIGATION <br /> 1868 Hazelton Avenue, Stockton, CA 952P.5-6�iMIT 1(I t ,�'iH <br /> �;•-,. :;:.•:P Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: 111 C UNIT IV <br /> ��FpR � <br /> WELL & BORING PERMIT APPLICATION <br /> FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application is hereby made to San Joaquin County For a permit to construct and/or install the work described. This application is made in compliance with San <br /> Joaquin County Development Title,Chapter 9-1115.3•and the Standards of the San Joaquin County Environmental Health Department. <br /> Site Location 7[.r E 11(P Sl�YCT_ Cross Street C'AS %T2Ef T City/State zip'15--')' - APN 2 <br /> Propertyr <br /> Owner. 114 <br /> 7Ai 4 CFFiCE _11t`t ZRt( u(. . Address q r, /1'ri 51�'cC I City/State Ti_ CY i zip 11�T' t, Phone(40)29 2-�l 1�f(p <br /> C-57 ContractorV—All',IC Rk`x-RV`fF-�; Address 2 11-1P_T_P'�iLDT_ '7;i. City/State IfFi11EL� 11&CS- PhoneN�'') 041 <br /> Consultant/Sub Cntr lil)M3 66 0V41' y,cl�dd ss L7/11 /'R/•::fel.Qu' 5T ATE '['City/StateC';kL41JD,C�Lic 3 1{ t7 <br /> . Phona6 10)QS(,-,700 <br /> Billable PartyiRuC'It"A 0k1a1.04"*'t''Tl'Address 1716r1~i/J/: <br />