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OP. <br />San Joagatin County <br />Environmental Health <br />aoasu &root Siocitten„ CA 93;202- <br />)41658-3449 For ((2)9 ) 4165134033 <br />Well 'Permit Application <br />SITE <br />ATION <br />MIT N APIR 4 zoo <br />NONREFUNDAELETIERANT EXPIRES II MAR ARM GA. 1111116Pi1ntainri1i ;Mt. 7. Iti ”. Ann I =ton es theolkw mattetteGen I itcwry, i rin 'County/or al perrntt to =mita& andkur i MAIN I tthe wank , .;.:,.: ..-1 4 I • : It ,r . 1ltr: 1:14: tri =mil lime 'with Sem <br />AffilPilill Vont* INNAlluprrertt 'TitleIttiutut 141115 Brut the Marotta-UN colSlin Jcestinin Illuitty fErwrnmthenttil litienIttl et...;: :.: nt. <br />SERI Ilaaxilion <br />sun litzuvueio carturtty Atlill Niue 4f2 "A/ Ix cs-P, t=3..: 1:1119mmattana RRES3S Anatesawc if= .. tadtat <br />Chwis Shutt rrirrennzna Cltty Zip Remit* "'D <br />AD I:BrIX aim) &oral 30-40191h) fINAEMRITY <br />comer Sum Zicilwaitm Ctomity 440amis aSam M )Th-5,7.g..1buom ame $10mcktnn 24$1701111 <br /> <br />Plum* 20-4013-33=1) <br />AM, WIPIIM ZMANDUENERT - smamm 181* Taqwwqmmtt- MaiLlligy% TUammamaano sisms77 mammsrtanwoo 31. RIDM slIm-1 - <br />C.S7CWItiMatImor Andrews 1:14 Elp_llibitt <br />4a c my 4Mmicadatmm It* ifttounta ClutualltmUff Slab tICM[tr a"3"3- 4mmem en Mlauw IRd_ ZODS-4,577-1Ma6 <br />GIS Cavil intim: >X , TomnEttiO Mangle <br />IIMMILEMMEIIMRSIMIVI= <br />m NEW wat.il BOWE (foal GeopRzam, wriaRcailuaci,i,1+11ANIDALGERADMREIr) DESIRUCIROIll otwasetoge talc* <br />SOIL BORINGS/ nv.431441RUIRE. MIMIElltERZ <br />wegau# Mtztadittm3rns Re.10. 3141-77 gm:mom GROUT <br />trathirr GROUT SPEIDIF IDAIRIONSFamtt141316 (clelualmt <br />:Ste Mizzlk MAIM friar IllianAttasertlxng tI/E112 Irenaltamaztitanu„ Zzaauterly 22Z11) <br /> <br />.1571.€41E.10.1 I ISISTALIATION 'TYPE CONSTAILICTION SPECIFICATIONS <br /> <br />RIONIITTOtig ING J*101.111:MNSISSI [MAIN SORE/C11.1 11101111311PLECAMIAIGE IFIAL111.7111-11.1EVEL MEILILCASING <br /> <br />ENTIVIRETITION I] AIR INANIOASI1ORKEE3I41 ©ING7IFHICRNESS -11/ TYPE OF.CASINO: [ESTEE& Ifiwc CHER: <br />WARR I] MUD 4E50W 410'1140F GROOT SISAL SW 'MEM ITSTNETRO SEISED: ,011trigERS ; titoNF <br /> <br />I] A FR SFIARGE/ EMILE FtliiSt+1 POINT (PIP cor(OPT)GROLUT SEAL IPIMPEID: rims ttite (MOTE: MAXIMUM FIREE,FAILL. DEPTH IS 301 <br />SOIL SMUG I] WSW AMER GROUT SPEC RIDATIONS 3t3ttamildi r(m/tPe <br />It OTHER: 11 OMER APPRIN . WRING CIDEPTHI SCO " !MOOED TRIMPIC JECUKOTII SIVOY;EPIPE <br />(011ThELIMPIIRICAS NG IMPOSED 34D ((if WES, I Ittoponittontiors i In mannnerttsBettian) <br />CORINIENTSz Cmga2,-IIMPtrovnal -aortetr„ eam--erati .11amiacily :2103.1) <br />NOTE: OPFSFTE BORINGS RECILMRE ACCESS AGREEMENT OR ENCROACHASENT :PERMITS. <br />.48 WORKING HOURS NOVICE REWIRED FOR memecnows. <br />.1 neraby codify That 1 have foreparad this applicationand that the walla be Anne in accordance With -San ,Joaquin <br />County Ordinances, Rides and Raglikilliona and &I applicable California State Laws. <br />- Stgned IwILNA11,06,/ Ilittlaltnnpany <br />Naldi am ..1-1rtIle Mistosnittier M(Ott19 Prtntittnntrm CITette <br />DEPARTMENT USE ONLY <br />SITE 11/64.13 IN UNIT /Vi ILE,ADDRESS: 4,40129.0 <br />WORK PLA'N DATUM Z.:, <br />akrizjeztt tram g3Evr/A...G.. <br />.,Apilittattion,Ancognagi SIL_Atkr7 <br /> <br />GEN ilescatil <br /> IN) <br />Anal 997 <br />Gront limpet:Alm' Sy <br /> <br />DIM <br /> <br />ft inn! limps:Nan Sy tahe <br />Deatituntion 'haw:tin Ey Mat* <br />CONNER= i/ CONDITIONS: <br />AMOli/AITIttIG GAILY: I FAO* <br />7 <br />PE =MOM SEE RAM OREM* REVD ST GATE ItERMITIISERNICE RESINEST4/ . INAGICE SIMOUNTRIENININED <br />A9102- kIrr 3497? b 1 44- 474/9 I S filit Oar" ."? Wfj, <br />C-577 WC -WAWA C-57 Letter s eraiitt EITCroztetrnheint dcz <br /> <br />2941R4801 WEE <br />S/1111/21317