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FIFTH Fu00RE 0•-, <br /> VVt--LL i AVrJL c;A. I (UN Ft,,XM uNi ,'V <br /> 5AN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRUNMEN IAL HEALTH DIVISION (PHS-EHD) - <br /> 304 t. weber, Third Floor, Stockton, CA., 95202 <br /> (209) 468-3449 <br /> NON-.REcUN ABLE PERMIT EXPIRES 1 YEAR FROM DATE;ISSUED <br /> an Joaquin County 0evelapmcnt Title.Chapter 9-i 1111-3 and tha Standards of SSIJ tV i ty Public il.in iccs,., HeQj% is vjsi <br /> �1 �y p CagL+R CQUM1ty Public Ncaltir Services,Cnvironmerltal Heath pivls;nn <br /> el _ 3�'f�C 1 ��)) phare rrne ! Assessor's <br /> • !ef 77•AMMDr If.", r,.., c. `R- ern „ >�nr (1 Tni.. `7 <br /> 1R0PERTY OwrtetCJc­e_ 17drr,I P-•..,K� r�G Address > T <br /> 1Ke i irf-r�c�L•Kr.i I,1./Ci yW-eJ..,or.�h Zipt5-{a Phone "Dv^ <br /> -S7 contractor�ne��rvM G,PJ�r,75rn.��G. Address";"!; W1�w1.h`�j l�rr City 1��I��cr Zip lJ��b LIcO si b a64 <br /> ^� {, �-• .._phones•_ <br /> •��e.•1...-.4�•�...r___..w�. 1M Fr •sAHsfl1t•:.la.+.e...--1Lno A— �Lee n...Al.._ .n..._/ <br /> aS Coordinates;J� _ _ Y_ Towns 1 Ran cfvl "- <br /> �P 9 Section <br /> rdORK TO B6_pERFORM�D <br /> NEW WELL,r SORING S CPT, GEOPROSE,MYOROPUNCH.KAND,AUGEft.OTKEI R7 g 13E51RUGY ION(choose type belor,; <br /> USuis ovRii iu w uv_m-mUNr_ <br /> in WFt I Pmptsnt IRF mpnl rr <br /> 'Other. . Qr :(1 r'9 �lLAalIOTf1tj-_ r v;3 ,r - - - <br /> .!1•HICIITC. ln ,N��wr' •h 1.l.ltc ;.,� -lla.� -•�.. Jn_26 •�_� L_1_- <br /> -. v � —_.•� - - � -. - r V�.UPJ J v - R Vc j __� —• <br /> TYPE OF WELL INSTALLATION TYPO CONSTRUCTION SPECIFICATIONS C <br /> MONITORING ' HOLLOW STEM DIA. OF BOREHOLE K::—MULTIPLE CASINGS? Q T>:S I hI0 WELL CASING OIl+: d r/ <br /> I t1f 1►wu t wnl U AIK HAWIMMV4UKI V&_N �l+alrvv 1 HIL:KNC.jS _ 1 7Yt DF CASING: ❑s I ttL d h+vG 4 c�T Hth1; � <br /> j:::wr` u MVV r1V1 (11 ;EF 79 37 GR v+SEAL,ri/re rr i-: LILI Irtr-MiC 1 iirC I V oc UaCLW: f♦AUG CRA17 Ili V�9 <br /> n e•nnr�r•r .rr f-n._�I.r e-rn. n.l �n r , •_ ^" <br /> int-l•rn. enwv_I�wr lei rn rear i —.Ir' — yv <br /> nnl <br /> 7 Sr111`Rllr}IAIr: n N6f.l rl of Ir'7FP a6Pca r1Y etnalurlr�coru 1Cr L.1 Z_�I.� ..Y �•a�. n,G Glr`6rty <br /> 11 lYNtrG6 o <br /> 1 R 11 OTHER CONDUCTOR CASING PAnPt]SFr)? !i►Y7 C Haf nnbeifeatfnna herel` <br /> COMMENTS: C gram /� Gf t'>7SL_t <br /> !MOTE: OFFSITE BORINGS,REQUIRE ACCESS OR ENCROACHMENT PERMITS <br /> I hereby certify that t have prepared this application and thaE the work will.be done In accordance wM San Jvaquirl CounTy CITW inces.State Laws. and Ruin; <br /> -nir:cy;:ie:i•n:a:.::a�-�rvJ:Iwi:r.'...Jrlij. �iti:ucv.::a�L•-uuciracy<ycrlia aiynawrc ccluuca Inc iouvrrinq. -i ccrair irrai in i�i�parFarrrro.rar.-..:u:c:=-%•n <br /> or wblch this parmil is!*Sued,I.Fhall slat employ PerSalls sub/ect to WORKERS'COMPENSA71ON Lawa of C'alifomia.^ Contfactoes Kiting or sub- <br /> rontracting siostum certifies the foltewing:-I r:vffY that in the petfolmance of the work for which chis permit is issued.I shall employ persons subject to <br /> ..w..,� rr vv.a .. •':y::�.1 rr,v v, e:i.+.::.u." <br /> CALL THE UNIT IV INSPECTOR 48 WORI<1Nr4 14Rfi IN AnVan1t"F FnR At I rsPn1fTPF=n INGP5:I1TInNS <br /> 9 - Ilpa/t.ompany v rJ lCGhn;G� ! .lir✓I�r / /�t rr7.� n vl�h ,.r e�f J�rr'r_+r�,t. <br /> Print Name 4C u r <br /> !t} Date <br /> JJ U. 7rnn <br /> SEE :SITE MAPAN _UNI•i' ';tY:.WORK,PLAN I"PATF_D',`.' - <br /> �`a .r✓ DEPARTMENT USE ONLY <br /> Application Accepted 8y / r l 1 vn?� I' S- L,&,t f _ Bate Issued I (� i U tJ Area Y�" <br /> _ <br /> urouc inspecaan ay, v Date Final Inspection Sy Dates <br /> Ci�ii•iti:�T.+r ti-v ii vi7ivirS <br /> ACCOUNTING ONLY: I AIC34 <br /> � PK r`AAFS CSF INKr'l aMC1f ItJT r7FMITYPII P?NFrK!! vCr••1_h trV n etc neo...v r oeovrre AGnr ICCT B 111�IAIr'.F <br /> .✓7 tn' /� 1 CTC, <br /> 40' _- <br /> r 4 ( 1 U L I 0 l ftoU t5 t# G v vLb:> — <br /> 1/18!2049 <br />