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12105/2802 15:33 2094683433 FIFTH FLOOR4 <br /> WELL PERMIT APPLICATION FC-RM SITE <br /> SAN JOAQUIN COUNTY-PUBLIC HE=ALTH SE VICES M�� ��r����"a7 <br /> ENVIRONMENTAL HEAL.M DIVISION (PHS iEHD) UNIT•'�� <br /> 344 E.Wear, Third FIatg, Stooktonr CA., 9,5202 <br /> (249) 468-344.0 <br /> N014-R EPUNDAB LE I-%ERMrrO(FIPES I V EAR I OAA t}ATLr LUED <br /> ll.,t1 is hprab,,j made tD Bar,joeL;vm-Cwnty ler a Per. to Ord n~uct andlor install t.�e wpr4 describe,+Ihi;aFplitatlon;s macWln mrrgliarro-;with San <br /> � gdur Courniv Develespmcnt"i1tle,G��pter 5 11 t'a.8�hd il�F Etandares9f Ssn oary�ln Coun;y PuIS1It FiEallh 5errivp�.Envi anrrantW F eaich Divi5iv-,, <br /> 4 <br /> Drossutraet <br /> city� <br /> c c.��tractor s C 'Ad drr' s �3�2 C Cc`z l�_cl>y -z+ �SIQ�r,�t •d '- � � <br /> :vaul:arrF l Soh CD:tractor - 44— <br /> Addr � <br /> Range, <br /> ILI "9 'p,14:b SP-PE:ZF-0FZME0L; <br /> YE'JEOWELI.1ho>~'NG(GPT.GUGPROBE.HYDROPUNCKHAND-AIIGER,MER-) jJai_S�RUC'FiQEV�nnaAa i* lye3an; <br /> p SOIL SOR�I ,I�# VO <br /> 1NL# 3`f!' 7mtP_T _ f�FRgUr�' �R,UT <br /> COMMIENM <br /> T'�PE f v1r�LL }h#STALIA�'¢�f TPPE QONSTRI)CTION SPEly1F1GATIO <br /> l�aj'n:'�tVl"PuRlhlG DAODOREHOE_jr— �LTIPLCCFIPR <br /> Si Q Yc$ AO W-11 <br /> 3D14WSTEM. <br /> P,%-FF-4,'T1 ON' a AtR I-At,�n,4F�IAVEN CA$ING THICKNESS 4> A)ryp,),-OF U.t%1G' p STEEL pVC p <br /> IJ Uu RJ-ARY DEP-H Cr GROUT 8EAr Z!J oLyTR>:F111E I`'fPE TO i3 1.15ED: 1130 i P <br /> SPARGE aPUSI-iparor GRt�t!�Sr.Fl.i��.IvSF'E�= Yes &u NOTE: tJI�NI FREE-F � F`' 1 0' <br /> L SOIL HOR.NG Q HAND AUGER GR0JT SPE02F!C A.T10.N9; f� <br /> APPROX,SORING CE?TH_oF& .?.G— OLTEO TRAFFIC BOX ar ®STOVi PIM <br /> a ' CQNS�`L�C7 ROAS1fVa PKPOSED r-0 0YES,I-St spectficadons heraj• <br /> LL--- NOTE: OFFSITE BORINGS REQURE ACCESS OR VENCR ,AcHMENT PPEAHIa L <br /> r-ALL THE UN7 rv' 1'4SPECTOR 48 WORKING HOURS IN,ADV,4,.NCE F� � L REQUIRED INSPEr- s��YS, <br /> I hereby ceftafy that I have p;raparetf this applicztion and thottlls'irarK ir�ilt be dole In acGcrciance ur9��i � ����`��:�" <br /> (:v.jtil,t;j ordin u[es gnd Rt-9 flations,knd ail applicable Calltorrda tate LAWs. <br /> Pdn;hJama � �"� dal <br /> DEPARTMENT USE ONLY <br /> 1�E fb9JFiF Iii CtI ;T JY FILE,AI3718 <br /> 4006 <br /> �fyb � Gq�kO�r <br /> / IA <br /> Appllc5�ion nxepted D;r Date Is.;.red <br /> C3rout Insi;ecFann E}• lnsp$Gtlnn BY <br /> _.e-strur.Gam Iftwectim ByDate ' <br /> 'ZOVIVEN k S r=NDMONS. <br /> IONS: <br /> 1-Crr_):.1r4TINGONL.1`_ A?" i <br /> FEF INFO E AfvIt UN7 Rl:mrr r- GRECwK# R D BY DA.7E Rh1171 BL=fiL'iGE EiE4 7 7I3�J Jl <br /> JG- � t+t1 <br /> LVC - A?l�cl2— C 57 Lz*ter of 3�iFCtii{1'iuC3 SOtl yc sign+ permit 1=ncraac Iriznt dot <br /> I l <br />