Laserfiche WebLink
'Jule.19. 2003 5;05PM "CONDOR EARTH TECHNOLOGIES''n "L'U� No -4022 rP- 2/2` <br />WELL PERMIT APPLICATION FORM SITE <br />y. <br />! �f i- 1 -)SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES MITIGATION <br />MENTAL HEALTH DIVISION (PHS-EHD) UN1TlW <br />purl 1 s zoos s;Iuvll��,'V <br />304 E. Weber, Third Fl<)or, Stockton, CA., 95202 <br />_R; Vj4jnlMti ENT HEALi r (209) 45$-3449 <br />F`c,�Iv1i1TI'StnViCES NOI4-REFUNDAB_ 1.Et=ER.MIT EXPIRpt., Yealt FROM cAYE CSSUIED <br />Apofication is hereby rnaoe to San Joaquin Cuvntf fcr 9 permft to misanrt and'or Insia;l the worl; daacri�c- 7hia appilcatlnn Is made In ccmptianao with Son <br />Joa4u;n County nviclopme,it Title, Chapter 8-11'5,3 and the Stanvards of San _'oaquin Ceunr; Public Health Servi:*v, BrrAir) m*ntal H49,11th 0M%i0n. <br />}�h Aassa�or's <br />WELL LosationyGC3r5� --- ^_Cross SlreetKtt>:L I.ri�lty �Ft i0 _ZiP�-PColi� <br />PROPERTY G%vner t�tKsNitrom dta>}s.rk-L-432151 _ 4' 1tY�, lifLZipy34A'7r-j4ra## <br />C-srCotttr.Zcorat+P lK tldress JA <br />��,,yyo��no��p�!E <br />Cons itant! Suh Con! a:,ar EN -� YAddrvssl'$� "` MU i�rt IvhoUL39 � _ <br />QIS C x�rcsir+atr s: X — r TMnUtt;p-jS.._--. pan9�.�o <br />ORK 70 ag PERFORMED;_ <br />EVV WELL! 8GR NG ( CI>T, UeCVR0eL, 1,) GROP' `NCH, HA,NC-AUGER, OTHER-) I; DESTRIICTION (&=se type beicw) <br />DSell. 50RING p _ , , , _ C1 Gvmscps <br />'Other: <br />COMI4IEN'CS: <br />I�l!E C1F WFLf IN 'TALLATION TYPE <br />(I N10NITCR!NC p HOLLOW S? cm <br />Q kXTRACTION p Ala HA,MNIVRi✓P!V-. v <br />O VA?09 Q MUb ROTARY <br />a AIR SPARSE Q PUS'r-I POINT <br />('L SORINC U HANG) AL,GRR <br />-e-O,AMENT!5; <br />CONStRUGC'TION SNFCIi°1GA7'1d�5 <br />` iii iF &iR��1 rlF rl._ �nU TIPt- CA5tNG5? �f 'f W5 Nb x�Lt CASryc p a:r �_ <br />StrtG i H;Gr NE55 — „_ iyPE vF GASItV �: 0 STEEL G PVC 17 O'I HM' <br />DI FTH OF GROUT 5EAt.___, TREMIE TYFE TO SE USED' G AUGERS HOSE <br />��cV'r'3kAL ¢ulln?f D: 13yes [INC (NOTE; MAXIMUM FREE -FALL DEPTH 1- 30"I <br />:RCPT`iPECIFICAT'0NS: <br />APPROX, BORNG D[PTFi ._ _ j] tIUL'rcC 7'ftAPP1C BOX rX a STOVE RIPS <br />_jtCONDIJ) OR CASING FR0POri :--? +� (Ir YES, Ilex apedgr.atlons <br />NOTE; QFFSI"rE BORiNGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. - <br />CALL, THE UNIT IV INSPECTOR X48 WORKING HOUR'S IN ADVANCE F011 ALL REQUIRED INSPECTIONS. <br />I hereby certify that I have prepared this appiicatlon and that the work will by done in accordance. with San Joaquin <br />County sces, RilesAnd Regusationz, and all appllcabiv Caiifasnia StateL,ya�ws. T <br />9lgned x Tide�CornP Y 0od3d1` z r �� w�C14 <br />PrintNama.,.C�-n?Y�f.R`Z\� <br />DEPART41 ERT US- E ONLY �— <br />SITIF MAP IN UNIT IV Fit -E, A00RESS: 5 0L—vu.�� f-6 <br />WORK PI_AA! IJQTED; J f9'. D {' 41) -CD1LL <br />Application Aeupted t y 4v � <br />GhoutlnaY�e^_tten Sy � - i-4� rJats� ? C Final Inspector 13Y <br />Destruction inspection By •� .-..- MQ4ts <br />COMMENTS I CONDITIONS:­ <br />--- <br />ACCOUNTINGCNLY' I AIDS <br />PE CODES FEE INFO AMOUNT R19AiTT;M CHECK # ( REC't) NY DATE PERMIT! SERVICE REQUEST INy'OICE <br />C-37— WC__-WA1V R.__ G-57 Litter of A0iOrfxation t4 5191r,. pe,rmit,,,,,_, Encroachment doc_ <br />