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A01T <br /> GATION <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES IVENVIRONMENTAL HEALTH DIVISION (PHS-EHD} ��ip(0 C <br /> 304 E. Weber, Third Floor, Stockton, CA.,LIS9 <br /> (zo9) a�$-aaasJ�G <br /> NON REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE• ne,5y mace to Sal.rcaQjm Cou-,y for a Perm t to cona%. artVo' '*zIIhe sv-_r6�e5CXj.-.r� T`is a;,nca`w•1 IS m2de =Jr"1�'ia'10E W h Sa*� <br /> n Garr..y Level;p;ent T 9e CI-apter c•4115 3 and le Stanch:S of San J-_aa_m C»nty PJD"c-ea-n Ser` --es Er% r-re:t -t'aftR by sra� <br /> Joz Aisessors <br /> WELL LocaltO 1 10 <br /> C•css S:.eet,�i csi nn _C1:y Z? Parte.= »nlmotm <br /> • Y f d�•ess e c ty �z'a�s "en.= - Q�f <br /> PROPERTY Owner .. <br /> VWi�'11LItvz Aderess C ty n Vista Zrp j, ] _ L'c; rt+a�e=7(}1' 37�i�815_ <br /> G•5T CprUat~or V.W. .— <br /> 4i�;terrl Seo--Frmnt �:caress 1 E. B�rgr C,yWx d1ard tr_, 513857_Pr,-e*�5�6G�53 <br /> Consultant I Sub ColiraclOf - <br /> X_,- <br /> Y Tom^shra VRamie 6E Semon 4GIS Cootdmates <br /> 'r`:OP_K Td BE PERFORMEDD_S-R'_CT,O\(Mt:2se ype W-.,%)Cf'Ev!11'ELI !BOR"JG(CPT C'O BRING CR ACI1,Fi'.N3-:.l3GzR OTHER') Q {)OtieR-BCR= <br /> t'~ )KSOILj+�'ELL� - p PRESSURE GROUT <br /> G'oLt Spec:'Icat,ons <br /> "Other <br /> COI►iAt=yTs <br /> PE F yy L INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> �y10ti'ITGRtNG <br /> FtOLL01N STEM DIA_0=BOR_40LET ��MLI-TI-L== CAS114GS? q PES O r F.E.I.CASING <br /> • EXT:t ACTION- a AIR HAMMERlCRIbEN CAStyG THr_KnESS_sefi y�TY?c OF CAS yG Q STECL �•`:V U O-^cR <br /> II L'Ar'OR g <br /> MUD fiOTAR f <br /> CSPTH OF GROL;f SEA. �.�TREMIE i YPE TO BE;,SED 3 A:.IGERS UCSF <br /> U AIR c}ARG=_ p PUSH POI-4T GROt1T SEALPUMP€D $'es 'No (NOTE MAXIMUM FREE-FALL DEPTH IS 30') <br /> SOIL BORING E3 FAND AUGER GROUT SPECIFICATIONS DI t_ CHrlr3lt 5%b2:1 e <br /> 0 OT>-ER A?PROX.BCRiNG DEPT, 30r .�60_TED TRA-=+C E—CX or p STOLs P P_ <br /> n OTHER,p,��. ISO rl YES.I st s`flecf':s,,:ns 1 eras <br /> CONDUCTOR CASING PROPOS- <br /> C, <br /> 'COMMENTS <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. <br /> CALL THE UNIT IV INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordl+� ul� laf`inr+c, and all applicable California State Laws <br /> s i svetCompany <br /> Ca'e <br /> r'r,t�ta'ne L. �= DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE. ADDRESS. e <br /> WORK PLAN DATED: l0 — �� o r i*;�� <br /> Date tssi e� � Area a��¢ <br /> Appffrab,on Aocepled By Fnal tnspecLon By Date_,,, <br /> Grout Inspection By <br /> oats <br /> DestnxGon Inspection By Date <br /> COMMENTS 1 CONDITIONS- <br /> ACCOUNTING ONLY. AID# <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK s RECD BY DATE` PERMIT IS ERVICE REQUEST 9 INVOICE <br /> C. <br /> WC_-WAIVERC-57 Letter of Authomctlen to sign permit^„ Encroechrnent dao 9/27/OJ <br /> E. 4 S C4 <br />