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08/03/2000 11:16 2094683433 FIFTH FLOOR PAGE 02 <br /> • RMIT APPLICATION FOM Sgt <br /> SITE <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES MITIGATION <br /> ENVIRONMENTAL HEALTH DIVISION (PNS-EHD UNIT IV <br /> 304 E. Weber, Third Floor, Stockton, CA., 95202 <br /> (209) 468-3449 <br /> NON-REFUNDABLE PERMIT EXPIRES T YEAR FR ATE ISSUED <br /> ,aci,in C is hereby made to San Joaouln County far a permit to c:nstruct andlor install ihs work described- This 3pptira iart is made in aompfr'ar cg wrGh gen <br /> :acuin County Dev pment T1t1 ,Ch pier 9-1115.3 ano the Standards'of^San <br /> ,'caquin Count/Public Health Services,Environmental Health Division. <br /> 'EL'-location Assessces <br /> Cross Street <br /> / ciry ZiRCE� Parcel# LI2--2-30_-C>a <br /> RCPER.TY Owne Addrese <br /> ,1 Ctry 1�K11` ZE Zip 6 hone# <br /> 57 .�ntrador U� r r J� Z _ /00 <br /> I� 'G(111Les, Znc ' _--e-�n _ � �Lit�k.s�' 0�0 (/U <br /> onsultant l Sub Contractor (��-�" h�n'`��A"�ess I�7 � l� CEty Vic# /�,,."� � � <br /> loSl�(J(nPhoi 75d <br /> IS Coordinates:X Y .TovmshEp R.,g.9— <br /> � Section <br /> 'ORK TO BE PERFORM D• <br /> NEW WELL/BORING(C. EOPRCf3E.H}•DROPUNCH,HANG-AUGE4,OTHER- <br /> �SCIL'BORING# Q DESTRUCTION(choose type befo,.v) <br /> WELL IJ OVER-BORE <br /> )ther: IJ PRESSURE GROUT <br /> GROUT SPECIFiCATlON <br /> ,MMEN 7 S: <br /> mia WELL <br /> -_._.�� INST�LLnTiON TYpE CONSTRUCTION SPECIE ATIONS <br /> -MCNITORING ❑HOLLOW STeWt DIA.OF 30REHOLE <br /> EX-RAC-710N <br /> X-Rw- �_MULTIPLE CASINGS?RYES Q NO WELL CASING Dlk, <br /> �:C AIGri ij AJR HAM.MSR/DRIVEV CASING THICKNESS <br /> TYPE OF CASfNG: El STEEL 0 PVC E)OTHER;_ <br /> ':AFvR h1 Y DEPTH OF GROUT SEAL <br /> -p TREMIE TYPE i0 BE USED: dAUGERS 5E <br /> nRCc PUSH PCINT GROUT.5:AL PUMPED', es J7,No (NOTE: M IMUR-A F EE-FALL DEPTH IS 30') <br /> OIL t30R1t1 D AUGER GROUT SP=CIFiCATION <br /> OTi-+ER: <br /> Q OTHER APPROX.BORING DEPTH p BOLTED TRAFFIC BOX or a sSTOVE PIPE JJ/,4,;�- <br /> CONDUCTOR CASING PROPCSED^ YES,fist speci6caticrs here): <br /> Olvt'�1ENT$: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS <br /> iereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> aunty Ordinances, State Laws, and Rules and Regulations of the San Joaquin County. <br /> " CALL THE I)Nr IV INS ECTOR 48 WORKING HRS IN VANCE FOR �L/L REQUIRED INSPECTIONS <br /> ;neo x ,\ Title/CompanY S I (/v r1 r 1 Fn U!irTvn Qnk� <br /> 'nt Name V ✓� 1..�► 1 Daze <br /> SITE MAP IN UNIT IV FILE ADDRESS !WORK PLAN DATED <br /> DEPARTMENT USE ONtY <br /> olica5on Accepted gy <br /> Date issued 7 G�' r'ea <br /> :Lt Irspec5on By �,��,V,� <br /> Date rma!InspecJan By Date_ <br /> ;s'Micn inspection i3y <br /> Date <br /> 'M EENTS:CONDITIONS: <br /> CCOUNTING ONLY: AID# <br /> F <br /> E Co"S I FEE INFd 11 AMOUNT REMITTED CHECK# REC'D BY DATE <br /> PPRMrr/SERVICE REQUEST 0 INVOICE <br /> C'57 WC/1NAIVERC-57 Letter of Authorizaticn to sign permit Encroachment doc 7/17/00 <br />