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�)r WEL•PERMIT APPLICATION FOM <br /> LN). SITE <br /> SAN JOAQUIN COUNTY <br /> FEB 2 8 2003 ENVIRONMENTAL HEALTH DEPARTMENT (EHD) MITIGATION <br /> 304 E. Weber, Third Floor, Stockton, CA., 95202 UNIT IV <br /> t1�1VIHU;dP�IEN I FiEA!! (209) 468-3449 <br /> PERI'JIiT/SF IiW_'tS <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 San Joaquin County Environmental Health Department. <br /> // a pc pppi Assessors <br /> WELL Location.j a�. /u2r7 Cc^ Aklkj Cross Street City D2C Zip 15.37& Parcel# <br /> PROPERTY <br /> Owner ripewo^rk . &Aerl<0. Address PO, BU 1/99 CityL0ke5a11: fA Zip9iOt'/0 phone# 6/9-576-2800 <br /> C-57 Contractor ap/or/�c'1•h"e..) 6&'S'rWi"C Address %53S- I�r✓.�s/rra�fx CitY=2r "SC Zip95//2, Lic#L &YPhone# 5/o+'f^280-6�S2Z <br /> Consultant/Sub Cnlr �+v.A E>•q)rT e2r)� jucAddress777U /'orr/?e LW �Z.:6(Obityqk�C� Lic#C5Hr7/r] Phone# ,moi/0-636 -�.,r00 <br /> GIS Coordinates:X ,Y ,Township Range____ <br /> WORK TO BE PERFORMED: <br /> ;NEW WELL/BORING (CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER`) 0 DESTRUCTION (choose type below) <br /> ,SOIL BORING#_S7-140, S' <br /> -3/ $--St 'D/•V /3H-Y-2 OVER-BORE, DIAMETER <br /> 0 WELL# 0 PRESSURE GROUT / <br /> 0.Other "i GROUTSPECIFjCATIONS �i`'✓c7f C,P/'"I/%o� <br /> COMMENTS: SU: <br />