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MAY-07-2003 14:44 URS CORPORATION 15108743268 P.03i13 <br /> 05/05/2009 14: 49 209469_ d ryr in rluur< ^�� w� <br /> WELL PERMIT APPLICATION FARM ITE <br /> MITIGATION <br /> SAN JOAUNIT IVAL H DEPARTMENT (EHb) ' <br /> ENViFtONMENTAL HE 96202 <br /> 304 E.Weber,Third Fl or, Stodk <br /> 3449 ton, CA., <br /> NON-REFUNDABLE pFRM1T EXPIRSS l YEA FR M[]ATE lS$UED <br /> made to Sen Jnaquin County for a pern'.t to dards of San r Instars ll theC�cty desFnvcrnmentahihed HeaThIpptlDaParie L e n oompltanae with San <br /> gppti�tion is hereby ter}7115.3 and the S / ASseWL u o G <br /> Joaquin County Dovelopment Title,Chep city �C-0-0 � Zip q 2C'�a—Parcel, <br /> I-�-� -Cross Stree: 4 3 C2 <br /> VYi:1-L l.ocatlon <br /> ,addressgl6 434`t�aQ <br /> PRGPEFYTYOwner SeR ' '$�,r - ,r1 pyi��'c`,^LiCN 6>5'� Phone �r�� <br /> j --Address, yv 5 r �r�,►rusTl h�i4CitY�•ChL---�'' <br /> C-57 Contractor t, Lid# CA Phone# ]JI O �� <br /> GanaUltant I Stab Cantractor�$$. Range Section <br /> Y Tcknship <br /> rats Coortlinates: _ r -- <br /> WORtC7p BEP Fo Et7• p pE57RUCT10N(rltoose type below) <br /> WORK V�IELL t BODING(GPT,G'=OPROE3E,HYDROPUNCH. AND-AUGER OTHER') ©pVER•BORE <br /> Q SOIL BORING# []PRESSURE GROUT <br /> []WELL# Grout SpeGtic3t1an5: <br /> 'other: <br /> Gr1MM!"NTS' <br /> TYPE pF WELL Ih!.TALLAT10t4 TYPE CONSTRUCTION 5PECIFICATJONS " <br /> DIA.CF BOREHOLr s�_MULTIPLE C�sING5� p YES ANO WELL CASING DIA:, <br /> ON[TORING 1&HOLLO -ypEOFGgSING: []STEEL $PVC ❑0T1�ER <br /> �] RAG 1 N p Alp -tAMMERlORIVEN CASING TH1CKNe5S��.^� <br /> r DEPT}' OF GROUT 3EA.��TREMIE TYPE TO BE USED: (]AUGERS $HOSE <br /> 12 VAPOR MUJ ROTARY v Na NOTE: MAXIMUM FREE-FALL.DEPTH IS 30') <br /> la AIR SPARGE 0 PU.H POINT GROUT S AL PUMP=O: Vas a <br /> IAP A.1CyeR GROUT SPECIFICATIONS: <br /> �L 6pRING BOLTS O TRAFFIC 90X or Q STOVE PIPE <br /> APPROX.SOF.ING 0=-PTH_Q2 <br /> 07H-cR7--0 OTrIER�� If YES.list Speak=tions hcre): <br /> CONDUCTOR CASING Pr20FOSeD?�_ <br /> 'Ct?fAMEtiTS:p1�dd <br /> suis G <br /> NOT��FFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. <br /> R <br /> CA,I I- rHE UNIT !V 1N5PECTO48 WORKING HOURS IN ADVANCE FOR ALI-REQUIRED INSPECTIONS. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance With San Joaquin <br /> County OrdinanCeS, les nd RegUlation5,and all applicable California State Laws. <br /> Title/Company <br /> Signed Y. <br /> • Oale_��, 3 . <br /> Prlctt Namm pEpARTMENT U$E ONLY <br /> SITE NEAP IN UNIT IV F1'-E,ADDRESS: <br /> WORK PLAN DATED'— <br /> �ti ���, ���7 <br /> Application Accepted Bye.— ~ Data IIns ed ^Date <br /> Grout 1n:pect on 8y Date Final Inspection By <br /> De:trvctlon inspec4cn 9y Oa`e <br /> COMMENTS CONDMONS:_ <br /> L <br /> ACCOUNTING ONLY: AIDP cal+u <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK# REC'O 8Y PATE PERMIT I SERVICE YtEt1URST 9 INVOICE <br /> G�/ rj <br /> C-57 WC_'WRNCR_ <br /> C-57 Letter of Authort=otion to sign permit tncroCChmenT dot, .- 1/251 <br />