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12/23/20014 1. -7:.31 9166365611 CASCADEDRILLING PAGE 02/02 <br /> _. LiK5-SACTt11.M�NF'p–lrtl <br /> 11/2V2004 16:114 FAX 9166792900 <br /> saw,J'Cmquin county [Al. <br /> u <br /> ]Environmental Health Departlfnlent <br /> MITIGATION 304 East Weber Avenue, fVtM <br /> 3rd Floor, Stockton,CA 95202 IT_`0 <br /> (209)468-3449 Fax:(209)468-3433 Web:www.sjgcv.org/chd 04 NOV 2 P"'4.f] 22 <br /> - <br /> ` N <br /> Well Permit Application :ll <br /> 'TE ISSUED <br /> NON-REt 1!plDAf�L6 PERMIT EXPIRES i YEAR FROM[Jb licalidn is Made In complIarm whb Son <br /> AppllcaUun is hereby made to San Joaquin County for a permit to construct and/or install the worn described, This a Health a�9nL <br /> Joaquin County DevelOPmenl TIDO,Chapter 13.1115.8 and Itt¢Stendar'ds 9T San Joaquin county t:rwironmental ligafth pep A9sessors <br /> l y!p 1 PameKi• <br /> WELL Location �• �4+^a Atf L-a Crass Street ��� <br /> PROPERTY, �✓ fc S` cfty�--Zip H <br /> MPhonag 4'Qf <br /> �_ �S�a �AddrO VLe. <br /> Q�mer - t---^t ,n,t Gi City OL%_ ck 7 l Phones "- j�b y <br /> C-57 Contractor a *n Address,.D— <br /> x07, Phone#�!4-t: `1 r Zx� '-( <br /> Consaaltatnt/Sub Cry�?k� �`` �$�� � �� �N L� <br /> Town.hlp Range Section <br /> 015 Cvordlnatss: <br /> O T ECSC <br /> WEW WELL 113ORING {CPT,GEOPRO5E,HYDROPUNCH,NAND•AUC3ER,OTHER`) U�0�.8ORE. DIAMETER typo below) <br /> a SOIL HORING 4 `� a PRESSURE GROUT <br /> �IVELL# CR4tlT SPECIFICATIONS—� <br /> n`Other <br /> COMMENTS: Q WL \ C A <br /> INSTALLATION L1CPE �NnTorrr_rrnw sP1=CIFIGATIO <br /> ,TX of WR�t, - „2� MULTIPLE CASINGS g MULTI-LEVEL WELL CASING blA Z <br /> MONITORING IWOL.LOWS W DIA,OF BORFHOLE� D VC OTHER: <br /> o EXTRACTION p AIR HlAMMER1DRiV�N CASING?THICKNESS fst� 4�D nP>=arAS�TMPETO �� ��OSF- <br /> ,FAL­.TREMIE II VAPORMUDROTARYt>EPTI 1OFGROUT 9 AIR SPAR[3FJ OZONE Q PUSH POINT(GP or CtsT)GROUT SEAL PUMPED; '4Ye9 I]No (ND7E:MAXIMUM FREE-FALL qE <br /> n SOIL.BORING (;HAND AUGER GROUT SPECIFICATIONS r BOLTED TRAFFIC BOX or n STOVE PIPS_ <br /> p OTHER'l�D OTHE APPROX BORING I]>;PTH, ��---- <br /> COSVDUC OR CASING PROPOSED, (It YES,Tr apec�icatlona M comment sectlon) <br /> COMMENTS: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 40 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> ' I hereby certi that 1 have hepar thi appllcatlon and that the work will he done In accordance with Ban Joaquin <br /> Cou y Ordi noes,Rul $nd gu Ons,end all applicable Callfornia Stats Lays- <br /> Signed x T;t1elCamparry <br /> Pr1ri Nam <br /> Dote f� Z3 4 <br /> DEPARTMENT USE,ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: <br /> WORK PLAN DATED. — <br /> AppllCetion Aatepted By asp Dale Issued_ I l j Z�f O Y A <br /> Grout Insp ctlon By Date Final Impodion W <br /> DestructIon Inapectlen By Date <br /> C011RINI NT$1 CON0MOTIS: <br /> ACCOUNT1nsG ONLY: All f FAC# <br /> PE CODES FEE INFO AMOUNT REMITTEE] CHECK 4 RECD BY DATE PERMIT f SVRVICE REOUEST t INVOICE <br /> 3 S o ,aOoc�-(o�6z 11 o ski �' <br /> C-57 We'waiVEP_ _ C-57 Letter of Authorization f0 sin er•rrlft <br /> 6 9.02. <br /> fJllt 9 I'. Encroachment doel� <br />