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10/25/2004 11:15 CLA` I PLEASANTON 4 12091683433 NO.973 D002 <br /> 10/25/2004 11:19 289466 ,3 FIFTH FLOORFILE COPY2. <br /> San Joaquin County <br /> ent SITE <br /> Department <br /> OCT �3 WebeTAvenue,3rd Floor,Stockton,CA 95202 MITIGATION j <br /> • 2{2719 4.49 Fax:(209)468-3433 Web:aww.3j90v.0TJehd UNIT IV <br /> _jIl fell Permit Application <br /> NON-REFUNDABLE PERMIT EXPIRES i YEAR FROM DATE SasUED <br /> pplk2tfon is hereby made to San doaquln County ter a permit W Cors ruCt an&or instan em worts described. This aOPBgdon is meds in campGance with San <br /> �aquln County Develapmant rids,Gtlapt+elr 9.1115.3 and die Standwda otSan Joaquin CoLrty EnvirannxntN HealthpDepartmeaL <br /> / ssersm <br /> I rGa c 1�3-7�PQ <br /> YELL Locat;an'1866,r crass sa�et 1 i .� on 1�cny �P s <br /> 7RwtOi PEa •. Address -Olt v?�7fe� Ofrl <br /> f Addre..✓7U r1 7w:,, •�s -pty" <br /> d S dip 11�CE Pnone#C S'3f�G G Z �-/ <br /> ;-ST Contractor .. •► � <br /> Conj rel da<<"fes r► at Phone# y'�2G�� <br /> ;onsudantlSub CntrC Addn sL9Lo �(�!! 4' .t�c•Gtyf�la�i►.�o:lidt__�_ � <br /> y 7orwtsttip Z.t(r Rart9s Sec"on <br /> :IS Caordna0as:X _ - - <br /> VORTn Rte rER�oR14MEb> <br /> �jEW WELL I PORING (CP cFOPr�o -t�1'DROPUNCH, D-ANGER OT►+s>t� 0 OESTRtype below) <br /> ORE, CIAMETER <br /> SOIL BORING#. PRESSURE GROUT <br /> r _ GROLT SPEGFICATIONS <br /> :OMMENTS: <br /> -yEE oft IFISTAI1TlQN TYPE r•nKCTQuCnnu sP£CfFICATfONS <br /> 1 MONITORING HOLLOW STEM DIA.CE gORFHOt,E �r Z0 MUL7PL£CASINGS a MULT14-EVEL WELL CASING DIA <br /> {EXTRACTtON Q AIR HAMMERMR1VEN CASING THICKNESS _TYPE 0�A�G: a YPE 0 BE USED: (j AUGERS Q HOSE <br /> 1 yppQR Q MUD ROTARY DEPTH 06 GROUT SEAL <br /> AIR SPARGE102 NE PUSH POI (GP OPT)GROUT SEAL PUMPEM U Yes 01 <br /> o (NAT/E:MAXIMUM FREE-FALL 30') <br /> SOIL BORING 17 HAND AU GROUT SPECIFICATIONS jJer% <br /> �� go, TRAFFIC BOX or a STOVE PIPE <br /> I OTHER:I N OTHER G APPROCONDUCTOR <br /> BORINCs DEPTH G — 1�,r5t 5 ecifications;n cor+tmOrt wale''') <br /> CONOl1CTOR Gf+SIIUG PROPOSED C F <br /> :OMMENTS: <br /> NOTE: OF SITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUU ED FOR INSPECTIONS. <br /> hereby certify at av prepared this application and that the work will be done in accordance with San Joaquin <br /> :o n#y Ordinan es u a d Ragul�dans,and all applicable California State Laws. / <br /> ed x <br /> Td1ny S/ 0 n, r.C� Mn <br /> Namur t 02 L [ <br /> DEPARTMENT USE-ONLY <br /> irrE MAP IN UN T IV FILE,ADDRESS: <br /> t1 r► k2�-C G'dl��'�� <br /> YORK PLAN D TLD: -o <br /> pplicadon Accepted y <br /> Date Issued /C) � j �Yt'� Area 4 <br /> trout ITtspecifon By � Date anal lr+sDeCbon By <br /> batmLuon Inspectlo�BY Dots <br /> vWWI r ITS 1 CCND TIONS: <br /> p,Ci✓OUNTfNG ONLY: AID# FACS <br /> PE r,ODES FEINFOAMOUNTREfMfi-MU Gt+tEG1t t� R�G19 BY GATE PERIIf�T!3ZICYIGG REaL1E5T lF MYrJ1�E <br /> 313b6� zZ s t�yoo4a <br /> C-�Letter of Authorization to Sign wMitz I:r+tr Ment doc ✓, <br /> -5� we -WAr ER_ �.dc...c. . <br /> MS4 <br />