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c <br /> Joaquin County ------- <br /> SITE <br /> ' Environmental Health Department MITIGATION <br /> +� 304 EasT Weber Avenue,3rd Floor,Stockton,CA 95202 UNIT IV <br /> (209)468-3449 Fax: (209)468.3433 Web:www-co <br /> joRquin.cA,us/ehd - <br /> \dLr_ a <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> oCcaton IC herebymade to San Joaquin County for a permit to Construct and/or instal)the work described. This app`icatiai is made 4)compliance with San <br /> .6 :coir.County nevlopment Ti !'.e,Chapter 5-11 t b.3 and ine Standards of San Joaquin County Err�/rronmentai Health DeFanment. <br /> Aasessoro <br /> Civ.�4L--np 8'" O -01 <br /> S'1_LL Locatlon 530�y�f t ��`k"o —Cross Street_ <br /> PF,OPERTY�*� °�5 DelaySZoGPhona ��— <br /> Addrass G�!; r ert eClty .SToe�Tc�n�Zip �1 89-2oln/ <br /> Address Po.ao" �n � Ci ro". �P�-- <br /> a;.57 Contractor F_ <br /> Carl.ultant I Sub CntrIir% r r'• Address 7 N <br /> J City Frrs,,v Llc#RG W;5ss Phone#CS ZGV-7a„?/ <br /> G�±.S Coordindtas'X Y <br /> Township Range tas7_ SeCllon Rfo <br /> '_v`tiriRK TO 6E pERFOR EU; <br /> BHYDROPVNCH,HAND-AUGER,OTHER") ES7 IN E type n=luN) <br /> IiNEV1XLLIBORINCG (CPT, COVER-BORE, [7Ah1ETz_R_ r <br /> - <br /> 1-Ag) 7. SURE GRCJT <br /> J1SOILSORiNGfi sa 0 PRES <br /> B WELL GROUT SPECIFICATION:i /wz C'p«+t� <br /> 0*Other <br /> C w1Vi ENTS: <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATtlO IN.TIfyLE'CASINGS MUL71•LE'/EL WELL CASING DIA, <br /> 0 rAONITORING [t HOLLOW$TEM DIA.OF BOREHOLE_ <br /> PVC <br /> SyTRACTION 0 AIR I-AMMcR/DRIVEN CASING THICKNP-SS___c TYPE 7REM EI TYPEnTO E`3$E[ Q U AUGERS 0 HOSE <br /> i"r.POR G h"'UD ROTARY DEPTx OF GROUT SEAL_ <br /> n AIiZ SPARGE/OZONE J PUSH POINT(GP or CM GROUT SEAL PUMPED' 0 Yes O N'-(NOTE:MAXIMUM FREh•FALL DEPTH IS 30') <br /> O(SOILBORING 1]HAND AUGER GROUTSPECIFICATIONS <br /> APPROXI 13ORING DEPTH D BOLTED TRAFFIC BOX or Q STOVE PIPE <br /> " OrHER'_0 O HER -- CDNOUCTOR CASING PROPOSED__ (if YES,list speclicatlons in comment s-neon) <br /> ` <br /> C.�'r1t+tEN7S; <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROA0,14INEEPa—T PERMITS. <br /> _ <br /> 48 WORISING FLOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby certify that I have prepared this application and'that the work will be done in accordance with San Joelquin <br /> County Rules and Regulations,and all applicable California Skate Laws. r <br /> Titix(Company_� " C-5 <br /> ;qned X= <br /> Date __.._._—•----� <br /> Orin(Name_ A_kv' �7 � � � - <br /> DEPARTMENT USE ONLY <br /> 31 E MAP'IN UNIT IV FILE,ADDRESS: <br /> iNORK PLAN DATED: <br /> Date Isbued �� b ,. Area-W - <br /> Appli;.ation Accepted By <br /> Data 2° D Final InspoGtion By <br /> :3r::ut Inspection By�_ — r_ ---• <br /> •�estructicn Inspection BY <br /> Data -- <br /> COMMENTS!CONDITIONS, <br /> I ACCOUNTING ONLY: AID# F r <br /> Pc COOES FEE INFO AMOUNT REMITTED CHECK# REC'D F3Y DACE PERMIT J Sl.R111LI?Rk'OUEST%� IIVVOIrE <br /> -57 WC -iNAIZVER, C-57 Letter of Authorization to si n permit Encrgachltren t dot„_ <br /> ZHD zs oz-oo l <br /> �ro,'zcoa <br />