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AUG 6 'a' 1 1 .53 FROM GFT71_ER RYAN <br /> TO 12094683433 <br /> 62123Iz8g� �6t0$ 2094583433 F <br /> FIFTH FLOWApt <br /> K2, <br /> WELL PERMIT APPLICATION FORM -- <br /> SITE <br /> SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES MITIGATION <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-010) UNIT IV <br /> 304 E.Weber, Third Floor, Sto+cktoN CA.,93202 <br /> (209)469-3449 off <br /> �1ort.igeRt}1yi�A,pt <br /> 16Wrr EXURAs I ma�M RATL MUED <br /> �p¢imsuorr rs hweby made to San Joaquo Course*tw a nwrmn to wsatta and/or fmsW:lam work desc%W Td1s Ypp(somUan csrrNkes 1» ca <br /> ba4m County Dewatawftm Tice chaoter S0 IS,S and the Standarfs of San,taagtttn County'ftwm HOW%$emom,Emtenaawlal Msrakh Dbmm <br /> Raw I X125 Assnssar's <br /> +AIFi.I.loet<t14t+ Goss StreK i+► Cs�y h �t �. Parbegit IZ 3" 2����� <br /> PROPEtTnY(5vvner a, + iu° 8 rt 10 E_ ..s,l�axs cKy }� Zp 9'�2b S Ahan z• 't s 8- S a s� <br /> "7 cont�aaor paarrm-r-00 e, _-- -cUy/ .ZP°_ .�.LkW7y°00f1p%wwl X j-A?y- 9300 <br /> carss>:tsas>t J Ss1b Gtnttrs;caor (9.17Lhr`, .a_�thC. A�e6s�'�/� S,,r_rM Ct ��r i� t,laa�•ZO� P!►or1 `��s�$"S�' �@ f/.2 <br /> Gmc4omlrtates'X Y TowrtSltip Raft$e- - Seetkn <br /> vmTQ"mmRhm, <br /> D NEW WELL 1 BORING(CPT,GEOPROSE HYDROPUNCX P4ANO-AUGER,OTHER-) a DESTRVCnON(rhacae t"betpwrl <br /> 0 SOIL BORING s. � _ � 1]o'VemmE <br /> 11 WCLL 1i -AAi4A-t ". PREssum GROUT <br /> -Oxher �3raW SPtvBeatiotss: <br /> COMMENTS <br /> ?ALF M C43mmto R92MTt 2 h <br /> HONnDpiNG I HOLLOW STEM DIA OF SOREHOU--r-MULT7PL.E CASING84 Q WS XWO WELL CAM*OA, <br /> Ajjks�vN {3 ALR liK4Mly6ERMRNEN CASING TSICXNESS�_ q T!PE OF CAStNC% UST F-L 11PVC O OTKEW� — - __ <br /> VAPOR lj MUO ROTARY DEPTH O�GROU-r S6AL .4'_ TREMIE TYPE TO BE USED. lx AUt3EFiS S HOU <br /> l3 A1R SPARG£ 0 PU-%i POINT ORMJT SEAL PUMP90- I!res p Tie (NCTE:M=MUM FREE-FALL DEPTH IS 301 <br /> a sae.50AINO 8 BAND AUGER r,RbuT SpacwcAmNS <br /> Ll OTHER- U 43TSF-Fk � APPROX.90MNO DEPTH c S 9L>L`s W TRAFFIC BOX or 0$T0\m <br /> COhmcroR CASING PROPOSED? dlo-- (if yjm ut socs%cmions t►eral• <br /> '�COt+1MEN'rs• <br /> NOTE; OFFSrrF- BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. <br /> CALL THE UNIT N INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. <br /> I hereby cesttfy that 1 have prepared thisapfication and that the work will 1>a dom In&=arder ce with Sari Joaquin <br /> County Ordtna hex ,and all applicable California Statte Laws. <br /> S>�ed x 71ve1Coatrpasty •` <br /> Pnn:kiArt+ss pato "/ <br /> /(/P�JAENT �ONY <br /> SITE MAP IN UNrr IV FILE,ADDRESS: <br /> WOW PL4N DATED: I <br /> Apaawron AccWed By, Date ism <br /> Gravy mspaeWw 8y Date .-Ftnal h pecw 8y <br /> t' unxtlan lnsoacoan By t)aisAr <br /> CoMNFom r CoHomws <br /> AC=Vf4TwG ONLY, Alm T <br /> P£C4Oe5 IEEE ihsIPC AAlOtSAf7 RE1slI`tEty CHECK* 'D BY VATF PEP.WT I SBRVWE R1:QUAST 0 DIVOICE <br /> --- 2.3 -��I 03 <br /> C-57�.� WC�,,..-WRZVER____ C-57 Letter-of Authorization to sign permt—Encr6achatent docs„ 9!27/00 <br /> FfiH 23 '431 75:09 <br /> c"'�9dSe3433 AfiGE_002 <br />