Laserfiche WebLink
04/08/2004 13: 42 FAX 9166792 00 URS-SACRAME00-00 U002/005 <br /> 96/18/2803 89192 2094EB3433 FIFTH FLOOR PAGE 94 <br /> WELL PERMIT APPLICATION FORM - SITE <br /> SAN JOAQUIN COUNTY . MITIGATION <br /> ENVIRONMENTAL HEALTH OP-PARTMENT (EHD) UNIT IV <br /> 304.E. Weber, Third Floor, Stockton,CAL, 95202 <br /> (209)468-3449 <br /> HQ?d:=jUf41P LIE R <br /> opllaaftn la hereby made to Son J eWh County for a permit La opnsrruct ardlor ostaethe work defaced. This appf+-,olon 17 mea In compllarwr.rklh San <br /> +oaqun CewrAy aa+nlapment73tr++ Chapyar!-1115 3 end lha St�dwdr of son aoapvin CeuAt,/EnvlranmenDl F4eRtrh Ucpadiftallt, <br /> As—Olt Q1,532 'jol <br /> AtELI N.awtlpn <br /> a nen,O' cronM16.1 C"v, ziP`IS� <br /> 'ROP>!`JtTYOwner {(��t t. <br /> Calyy'",Ulz, 9Y5` Phoma <br /> l RSD Howt � gra•�,�.� /!'lGrt�net �(2:�G Sf 1+erue��}}�a:31� SKdt� <br /> bTCenin {� <br /> do0, _Addr�ac <br /> Censufonl J Bub Cr11r Address'^nl1C7 :tit'1.• 0 c`I• , r.c#h L1CM �#�„ Plrondf �� —v�d <br /> Gf8 Oawdihtltl,V--- 'y—-- — Townifilp_ ,f+ RB $Mogen <br /> p N WELL j 60FUWG (OPY.09OPPAGE,HYDROPVNCH,1aJA1N"UGEFi,OTHE.ft•) D DIESTRUCT ION (rJ�eese Oe+aMowj <br /> SONLBORINGB I) VErt-BORE ISintYt R <br /> ELI s ft 4 a PRESSURE¢ROUT <br /> pp.�� OFiOl1T 6>'ECIRICAT10tJa <br /> COMMEMS <br /> TYPE PE WML �aT1+�IJ►TIOJ�M r► s „ r I <br /> 'QMONITDWNCf 1OLLOw STEM Dw of BOftrwoLE S Q MULTIPLE CASINGS p?ALA-T 4-EVBL WELL CASING DIA: <br /> X11 EXTRACTION a AIR HAMM4iRMRIVEN CAs1NGTHIGWHSB c 1 c) Pp eA[:INt3: �51EEL �1►C p OTHER: <br /> trAAelt u MUD ROTARY MPTH OF GROUT BEAL � L,UR�Mwore. <br /> T=1E TYrE TD BE USED: 13 AUGERS 08E <br /> `N,z a>°AfcGE1 OZONE 0 PUSH POINT(GP or CPT)GROUT SEAL PUMPED; 13Y.4 o MAXIMA WIA FREE-F/1�L DEPT IS 30') <br /> �9bll.t]ORIN4 p HAND t . GROUT SPECIFNCCTlotft [ a. t ,t• -e -:7110 b2'obn r' a <br /> 11 OTRER: (l OTHVt _ , APPFOX.DOMNG tMPTN1 t! 4M LIED TRAFFIC BOX ar Q MVE PIPE <br /> =NhUCTOR CASINO PROPOSES of TES.lltlIn GOIhRNrltz*cWn) <br /> cc"E1ITS: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AoREEMENT OR ENCROACHMENT PERMITS, <br /> 45 WORKING HOURS NOT4CE REQUIRED FOR INSPECTIONS. <br /> I hereby aortify that I e epapplicetlon amd that the work will be dome In accordance with Sen Joaquin <br /> county Ordirt R5a3uls.and all applicable Cattfarrtia State Laws. <br /> r { <br /> S}9Rpd R TWalCorrgerl A <br /> r <br /> Ptin1 Nmns Dole <br /> DEPARTMENT USE O LY <br /> Stye MAP IN UHIT IV 19LE,AD RES!: 3 2 2NO-r+):6 r St re C A <br /> WORK PIJW DATED". r t <br /> AWeviion Acm fWd B]! ]Ca��Y i A . L NA e—C Y,,in 9.1 Date iswod A Ll <br /> Grautlmpsellen Bye DM Rnal InNp4clon OY Pt*e <br /> 0*2ULKO)n N117 adlorr Dela <br /> CDWMEWTSICONArr101V= S ynW-9 t <br /> W 7 <br /> ACCOUNTING ONLY- AIDN FA4:k Ar o�51V tzi)#a <br /> PG CODES F11g 1Nto .MU NrrREftTrI D CHECK s RECD RV GATE PERM rT I SERVICE REQUEST 0 WV01C1; R W V. <br /> 3501 9.o0 3!5337 ?I el SR# <br /> C-57 WC -WATVER:_ C-57 Letter of Aurharl2atien to aigr,permit Encraochhi"%'docT 9/30/02 <br /> 2 'd 002E 13rN3SU1 dH Wd9ts =2 b002 90 Ndd <br />