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02.."17/2008 14:40 5102374574 <br />-021/19/2,0216 17:2'" 2FJ94r@3423 <br />---���r-� San Joaquin Cc <br />y c <br />Environmental Health <br />600 East ,Dvviin S txcct, 5toclaom, <br />('W9) 468-3449 Fa%: (209) 468-3433 <br />� iFo Wail Permit APO <br />NON-REFUNIDABLE PERMIT EXPIRES 1 YE <br />pppligtlan Is hereby made to San .Ioaquln County for a permit to construct and/or <br />Joaquin Courtly MAVAIO.Dment[ 'iiitle, Chapter 9-1115.3 and the SI indards ar San Jc <br />WELL Location yT ✓ T `l �� frrnct i 3V@C!� <br />PROPF �•'�' "' - � <br />Owneti11 <br />C-57 Contractorfo�y1_ <br />3001 <br />conitiltnnt l Sub Cntr 15-N �_AddrssA !Ele+2 <br />Gt3 Coordinates: XSs��� r . Y,1 •� t ' <br />WORK TO BE PERZQ RNLFP <br />Q NEW WELL! BORING CP , GEOPROBE, HYDRC)PLJNCH, HANG <br />II Son- RIORING 9 WELL # Yr^ r v t ix 3 vyl� <br />Q <br />CC+Mtv1ENTS: !�V �-kL J'�- t", 1'x,1 <br />TYPE DF WELL INSTAI.�A ION TYPE GS7HS RUCT1UN 5rcL <br />Q MONITORING 0 HOLLOW STV0 DIA, OF i CORCHOLE2 <br />Q EATP-ACTION p AIR HAMMF-9/DP,IVEN CASING THICKNI188_ <br />0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEi <br />0 AIR SPAR y OZONE p PUSH POINT (GP or CPT)GROUT SEAL PUMPEC <br />0 SOIL BORING ii HAND AIj(V-R GP.Ot!T SPSCIFICA•rIC <br />` (pTHER: N THER„N —'Pr APPROX. BORING I EV <br />CONDUCTOR CASING <br />CO <br />QRSITE BORINGS REQUIRE ACCESS <br />48 WORKING HOURS NOTICE: <br />PRECISION SAMPLING PAGE 02%02 <br />EHI.' FAFiL 132 <br />inty <br />)@111 txxxent <br />" SITE <br />'A 95202-302q ��� $ 4 NUITICATIaN <br />b: wwtiv.sj�ov,or i¢hd LIT IV <br />F3�J�J�RL:h 11,I I , <br />atlon ;iS- <br />R FRIOM DATE tsSU81) <br />tall the work descrlhed. This application is made in corrtpliancl� with San <br />uln Gaunty Environmental Health Deparin+ant, <br />Assessors <br />pity�C�Gi�'ASJ Z;pQ,�ab� P�rceM' c�3�t�{ d l�' <br />:Etya�N �ziP �tf <br />vP nef <br />s$fp4��•�O O �D �- <br />Ipl L#5-�lona�k��.+T6 <br />-r <br />�r ,�-t'r,,,,• <br />Lic� PnoMnlr5LP '62 <br />CityQ�.. <br />Range 1p {? E E9actton ac <br />Jj <br />GIBS � <br />af'VZ) <br />ICA r � <br />In - <br />11 MULTIPLE CASINGS O MULTI-LF-V5L WELL CASING DIA:- , - Pr <br />TYPE OF CASING: p STEEL 0 PVC b OTHER; <br />(� TREMIE TYPE TO SE 1.1311;0; 0 AUGERS 0 HOSE <br />_s p No (NOTE: MAXIMUM FREE-FAt4 DEPTH 15 30') � <br />'t^z,Sci )' D 6OLTEC 7RAFFIC BOX or GS TOVE PIPE <br />iCFOSED 1,4ff . (if YES, Ilst spedfivaliuns in commentsection) <br />VV <br />ev THE ) ODESTRUCTION (oho0setyprb60W) <br />Q OVER -SORE. DIAMETER _ <br />0 PRESSURE GROUT <br />+rvklfl <br />GROUT SPECIF'iCATGNS <br />GREEMENT OR ENCROACHMENT PERMITS. <br />QUIRE13 FOR INSPECTIONS. <br />I hereby rartify that I have prepared this Opplieation and thathe work will be done in accordance with San JoagUin <br />Caunty Ordinance and Regulations, and all applioala` California s to Laws, <br />5lgned x <br />Print Name <br />Name <br />,SITE MAP IN UNIT IV FILE, ADORESS:�3 <br />WORK PLAN DATED: 1) <br />Arpilcat un c -epted By ^t y �� ly <br />+arout Inspection 3y ' 1JY� " --;Date <br />Ru Date <br />GOMMENTG I <br />ACCOUNTINGCNLY; I All# <br />PE cooFs I FEE INFO II ANtOUNT REMITTED ` CHECK 0 <br />•- <br />RTMEN USE ONLY <br />`) tti1 r yl p I' <br />f <br />^I 1 Imo', rC <br />Gate Issued <br />3 iQ � L'Lr=fnal inspection 3y%%� .�- <br />C-57— 1vVC_-WA1VSR— C-57 Later cf A <br />LED i9.12%001 WES <br />9111/2007 <br />V Z_ <br />'D SY DATE PERMIT I SERVICE REQUEST INVOICE <br />:n to sign permit_ Encroachment dac� <br />S~R0� 53��y <br />