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UNIT IV <br /> ql; � -I� WELL PERMIT APPLICATION PORN[ <br /> Q� ��P J� <br /> Q� ,lO.AQUIN C1�'E1NTY PUBLIC HEALTH SERVICES <br /> � SAN``5� ENVIRONMENTAL HEALTH DIVISION (PHS-EHC) <br /> 304 E. Weber, Third Floor, Stockton, CA., 95202 <br /> ✓� QCG (209) 468-3449 <br /> NONREFUNDABLE PER?41T EXPIRE 'YEAR FRCM DATE ISSUED <br /> pppicaticn it tseraby made:c 5aa .��u:^Coursy tai a cemit to Constn:c:andlur install Lha wor+descrii:ed This as7alicztion s ma;.e rr corntianc_ Hot'• <br /> Sar ir2l1C n County ^evPiapmPn;7-1e Chat/er 5•t 115.3 and the 5tandzrCs cf Sar. !oaeu;n Co,,nly ?ubiic Health S=rrsmc, tit'`•Assesso'Health Division <br /> z' 95376 Parc_sst 50150-18 <br /> WE_L Location 7500 W l�.th Street C:.ss S7eetf:hri sman KcCit;�sr..a.c�— a --- <br /> Carl & Annamae Navarra <br /> PROPERTY Oavner 475 L1 Bletaett c,tyTracy zio95376 phcnea 2 8a6-0005 <br /> dGr__5 — <br /> Spectrum <br /> _ectrum ExplorationAe� <br /> C_57 Crn:rc orass 2365 Wigwam Cit�tockton_e 52 L: 12268-Pni-e2} 5= 712 <br /> The San Joaquin CompanyAd�res: 8617 Etcheverry.-;y Tracy L_ Pnoner(209) 832-2910 <br /> Consultant:Sub Contractor <br /> G{S C:ord.natss:X Y Taw�sr iD F.ange SeCzior <br /> WORK TO BE PERFORMED <br /> V11JE-id WELL t SCRING(CPTE:IRCBE. HYOROPUNCH.HANG-?UGE?.OTHER') '� DESTRUCTION!=t..00se ype 0e;0w] <br /> �SO{L BORING# n Cep FtE <br /> V-dV;LL d--- QE;SURc GROUT <br /> coMMEVTS: ee Attached <br /> TYAE CF WELL INSTALLATSOK TYPE CONSTRUCTION SPECIFICATIONS <br /> 0O?jITnRING OLLG'r':STEW DI.A.OF BOREHOLE 6" VULTIPL.E CASINGS,a YES 0/N0 lhE:-L CASING DIA' 211 <br /> 0 FXTRAGT[ON AIR HAIAMER/ORf�E�I CASr.NGTHCKNESSSch 40 TYPE OF CAGING: a STEEL '�VC 0 C-,HcFZ: <br /> C3 <br /> VAPOR a'IUD ROTAFY DEPTH OF GROUT SEAL 6TAEVIIE i YPE TO BE USE:): a AUGERS eDSc <br /> a AIR SPARGE InUSH ?OiNT GROUT SEAL PUMPED: ees a No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> �(;IL BORING. a HAND AUGER APPRCX. BORING DEPTH 21' �OLTED TRA.FFEC BOX or p;;TO`dE PIPE <br /> a OTHER, OTHER CON]C CTOa�51NG PftCPOSEC�? NO (�rYES lstcoecifc�rior.s' erel:_ <br /> COMMENTS:_See attached Figure_ 11 <br /> NOTE: OFFSITE'SORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS <br /> I rerery Ccr-.fy;hat I hvie preparac this aopoiC^e inn ;Inc tt;al tine work wi] 5e cane in acrzrhance w•.t^San.'oa'zwin Courty Ordinances. State Laws. 3n.R::'es <br /> and Reculatior,s of the San Jcagcin County. Horreewrer or;:censed agen"s signature tea'.fies:ne'ol:Owing' ­I Certl'sr that in rhe perrorriterce of the+verk <br /> for which this permit is issued. !shat1 not employ parsons subject to WORKERS'G�7MPE/Y54T:ON Laws of C3lYomia." '_CntraGtO or 2:_,t <br /> ccr%trac*ing <br /> _contracting signature certifies the zottowing: 't c91ri1y f,'^at in!,5s oerfor^7anca-,!the.cork ar r,hich rhr5 permit i,:issued i shad errl_,'�•y to <br /> wORKEPS'CON:PE.-W ATiCN Ls s of California,' <br /> THE APPLI ANT MUST CALL 48 WORKING HRS IN ADVANCE FOR ALL REQUIRED INSPECTI S. <br /> Da'e 3/23/00 <br /> 51_ned x l7 �• 'fitlz <br /> �r�:r� ! <br /> Cs W <br /> SEE SITE MAP IN UNIT IV WORK PLAN DATED- <br /> DEPARTMENT USE ONLY �© <br /> ACL7iicat:o'.4c�eeieag f �— _•Cate 'ssueo �f- d� WA <br /> C ouilnspettior By_—IJI�nn.tr+Cilf� Date t l -L- -a OC nai Inspection Sly Date- <br /> De_trUCnOt,IrzoeC:ion By Date — <br /> COMMENTS!CONDITIONS: <br /> k_ACC0',)NTJN,ONL Y: o aIC� PArAt <br /> s — <br /> °E ODES I FEE 1NFi7 AMOUNT ?Er'111TTErJ I CHECK if � REC'O BY ; OATE IPE?MIT i SERI,/ICT-REQUEST s �II INVC1Cc <br /> IiO } I K I n Sig.# D O z-Z S D.SJ4 <br /> i= ;; LICE;USED CUtiTR:1CTOR 1Ii�5T S;Gti i.ICENSc 3[�+'Ci�KT`R�' CQ1Q'ESr�TIOlti �il✓C: aR. TCL�ti <br /> f1dT7 T'1 -6/2_,'oc Isrcn b6rf,iMl <br />