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i <br /> 06/05/06 MON 10:36 FAX 925 36-1- 7275 TERRA VAC NOR CAL <br /> . r :: . R .. : FILE . CO" <br /> a_ 45, . . <br /> 04,41ilim C61,1 lit <br /> �>a, „r::fi JrJii�ria I'Tit���` 'altiilD pp' _ 'SITS. <br /> i rr pJil 454 dist 1Zreht:CAl'l?Il1lel- .3i I Floor, Stocj:vcC!1, l r 97202- MITIGATION <br /> (209)468-34. 9 I IN: (?09} 466 3 i3:Web: 1d w�v.CQ.c,,I; :.4,;c uin.ca:usf iicf <br /> UNIT IV <br /> NON-REFUNDAE3LE PERMIT EXPIRES 1 YEAR FROM; )5'rL-1ggUrD <br /> :iF:rli afion is he-Mby made to San icac,uin County ror a pr?rmif tr construct andlor install thr 9. i r <br /> Jaaquin Co;:n7 y DevelopnG, t Titie.ChGpter n-1;13.3 and trc S,andard5 on f SaO Ic uirl CoLIWI I li�ic'.UiFlj) c=_3.ron is Made i corny liunce 4viUi Sa;' <br /> 7 OaPaFlmont. <br /> W /.ELL Location_.- q Q Assessors <br /> Cros,Strout <br /> PROPS <br /> CJ:..r2r._,r��rr�Ir crnu. cyh �-�'!.f cidress_ •(], ZL <br /> - <br /> r r <br /> C'tv l;i.�Lfl,l_''i ���s :" PriUrla zPJci -c�tx5�_�� 1 <br /> C-or,sLtiiar:i i„l;l: Cntr � C � �� <br /> - _L GTc,G Liu» F'rrrnel;. q 2S 7 3-f ( • <br /> ,I RK TO 8E FIE FORME[% -- <br /> 0 NEW WELL!BORING `U-PT.GFOPROEE <br /> CF" 1-ROPUNCH,: AFT-AIGER <br /> yon_sorrvG OT ESTI <br /> RUCTION (choose l;pe below) <br /> i i;._)VER--ROnE. D!.4r,.ET ER <br /> 11 1_-!i15SURF GROUT <br /> — — - ......._.._.�—.. - OUT E3rECIF;CA.IONS <br /> TYPE OF WELL INSTALLATION TYPE LO;yg7Rl1CT!ON SPCCIFICATIUNS + <br /> rjVIONITORING IOLLGiJSTEM <br /> DIA.OF SORCHOLE S!X " fWELL CASING U <br /> TA']iMU <br /> f)VAFJi' 0HA-MI.1ER/DR;VEN f)`TFEL [jPVC QOTHER:EPTH OF GROUT SCALJ vtJD 40'F•,RY n <br /> — <br /> ic,'vir� T,:)SE USED: ij AUGERS (}11 OS <br /> IlRSI'r�.[iGElrr�Gn f1L'usHi=GINTrcPcrCPT)G1citfT ;.=_ALPurIPD: I?�`;s...._.I):, {i'•its-1=: !tifAXl[1rUiJlFRE�-FALLDEPTfifS3Q'} <br /> �CiL lm,0RIN%{ <br /> [J I AP. L'hF:fi ,Rc'u r u�' l iFiGA I`�i)NFi <br /> 11 OTHER:. ------- - .. ..._ _._._. _ _..... <br /> C:THLR�------ APPROX.BORING Uf=P T H _ -- <br /> d 00LTF.J T R.QFFLG BOX or 0 STOVE PIPE <br /> CUItlrs•IENTS: CONDUCTOR CASING P OPOSEO 0f YES,list specifications in comment section) <br /> �w '�e .. <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGIREEf4r1I,-,!-r OR ENCROACHMENT PERMITS. <br /> P,,WORKING i;OEJ 'S NC7TICE REQUIR ' ""R ::NISPECTiONS. <br /> ! hereby certify!that f have Prepared this af]i)Iication and that the work i!: i-F ,bne hi accordance with San Joaquin 1 <br /> County Ordinances, Rules and PP-quiations, and all alala)icai,fe Californi- .�.t :- Laws. <br /> r. <br /> ,C j <br /> D-F.QARTMENT USE -- <br /> SITr MRP IN UNIT IV FfL! , ADDRESS: Z�%5b - _ " <br /> WORK PLAN DATED: �j�d <br /> lrpplic;d: n Ac opted By <br /> late Ist,_,i v Area`�� <br /> Grout Inr;ectiun SV - <br /> --._ Date Final In:{Jr.c:?a-!rt•;: ---•----- _ <br /> Destfucticn Ir7srieC3ian ay - -- - --- --- -- Gate <br /> ._ I7a1r3 — -- <br /> COMMENTS 1 CONr]IT�ION�ST: <br /> /?GCOUNTIrvC�i7fdLY: � Aft�� � - "'"..:^�^-...^^,•.�..�..._.... ._ -- - --�____ <br /> f PE CODES FEE INFO AMOUNT REMITTED CHECK# - <br /> RECD BY DATE PERMIT(SERVICE REQUEST# INVOICE <br /> 0 54 _ 79 ; SRS <br /> C-57 Letters of Authorization to sign p:'fr 7%ir _ Encroachment dac <br />