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07/30/2004 12 13 2094683433 FIFTH FLOOR PAGE 02 <br /> JUL-28-20124 12'23 CAMBRIA 1707 935 6649 P W-j1W� <br /> Eau ovaqujin 1-tounly <br /> Environmental Health Department SITE <br /> 3 04 East Weber Av loor, Stockton, CA 952;02 MITIGATION <br /> (2D9)46e-34 {�09)4d$-3433 web „Ir,n,q,r.3jgov orgleM UNIT IV <br /> a <br /> NON-REFUNDABLE PCOMIT EXINRES 4 YEAR FROM MATE ISSUED <br /> Appli=t,on is hereby made to San.Joaquin County for a parrot to construct and/or install tho work dgtcnbed Yh;z spphcaEon is made in compliance vnth Sar <br /> .loaqun CcwnTy Davetopmera Title,Chapfmr$1115 9 and the Standards of San Joaquin Conary Enwronmenmt Health Deparrment <br /> S Assessors <br /> WELLI-o=%10n +l0 U t �-r'J erossSeeetL 5 s qtr �c -- za y.e3o-°- <br /> PROPERTY J <br /> aNm 5 h G.l1dd r�7'-�pSAe1-ta,i..eDr,; City T t� Z,p �53� orrrt# <br /> G5T Cantr34Scr <br /> Gensutlanl l,S+*v'Errtr n.. Address L]O p4r -4s.S! r Clp e�+� t ice Phorr� a - 3 <br /> GIS Coordlnalm X . 'y T7wrtship Range SectI10i1 <br /> WORK TO BE PERFORMED <br /> NEW WELL GRIN CPT,GEOPRo$F_HYDROPUNCH,HAND-AUGER,OTHER*) 0 DESTRUCTION (choose roe beton) <br /> jrSOIL S4R1NG PI'->r_� C ,�._ OVER•BOPF- DIAMETER <br /> Il WELLPRESSURE GROUT <br /> a`Other GROUTSLPECIFICATIONS. <br /> COMMENTS <br /> 'HYPE OF WE),1 4MSTAL-LAT?ON T'YPIE CONS-fR0=0N SPECil jr-A-n0NS <br /> 11 MONITORING 1)HOLIAW STEM DILL OF BORemoi-E�r u muLnPLE CASINGS D MULTI-LEVEL WELL CASING DIA. <br /> 0 EXTRAC7l0N t1AIRMAMMERMWEN CASING THICfa`IESS 'TYPE OF CASING IIST9EL PVC p1H <br /> p VAPOR MUD ROTARY DEPTH OF GROUT S TREMIE TYPSTO BE USED �A d HOSE <br /> WR <br /> SPARGE!OZONE PUS}I POINT(GP or CPT)GROLITSEAL I UMPED XYes d No (NOTE: MAXIMUM FREE-FALL DEPTH�S 30') <br /> IL BORING a HAND AUGER GROUT SPECIFIGATIaNs <br /> a OTHEFL— n OTHER APPRaX 8OR1NG DEPTH! lt)a;?l ___Q BOLTED TRAFFIC SOX oe 10$TOVE PIPE <br /> COr1OUCTOZ CASING PROPOSeD 4,Lo (+r YB9 fad spactMeations.n temrnaritseeson) <br /> COMMENTS^ <br /> NOTE_ OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PFERMITS. <br /> 49 WORKING HOURS N0710E REQUIRED FOR INSPECTIONS. <br /> 1 hereby certify that 1 have prepared this application and that the work will be done ;rt caccordance with San.Joaquin <br /> County Ordinances,Rules and Regulations,and all applitabla Caiifomia State Laws. <br /> sed x TiIIelCorrtpenY T..e, <br /> Pnnt Mama <br /> l DEPARTMENT USE ONLY <br /> SITZ; 4AP fN UNIT IV FILE, DR S. <br /> WOR9C PLAN DATED- 2 IfP%-f <br /> -t,t,,,.�.sr Date+sense 3v a a�re>j z�9 <br /> AppD=15cn Acoeplgd sY .C1 <br /> c,��_.k,_ - <br /> Grant Inspecdo"6y _-_ date Fif181 Inspection By OaeB <br /> Des�ruCtlah Irrspartlen By Dal& <br /> COMMENTS]CONDMONS <br /> WTi <br /> LY AID# FA <br /> -1110111 _ INFO AmouNT AF-mrTTED CHECK A RECD Uf BATE PERIAff ISERVICE REOUSST91FIVOICE <br /> d ,� 13 6 sR# o <br /> 1 ,57 <br /> C-57_,x, WC-_ WAIVER C-57 Letter- of Avihorrzatron to sign permit Encroachment doe <br /> 9/3 V2003 TOTAL P 22 <br />