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%one <br /> Date: V12-, <br /> Michael M. Niblock, Director <br /> Community Development Department <br /> 425 N. El Dorado Street <br /> Stockton. CA 95202 <br /> REVOCABLE PERMIT APPLICATION FOR GROUNDWATER MONITORING WELLS: <br /> I/we do hereby request that this letter serve as an application for a Revocable Permit for the <br /> following <br /> Use and maintain 1 Groundwater Monitoring Well(s) in the City's right-of-way at <br /> the address listed below and as shown on the attached drawing: <br /> 7647 Pacific Ave., Stockton, CA <br /> The undersigned has received a copy of and fully understands the Standard Conditions <br /> governing the issuance of a Revocable Permit for a Groundwater Monitoring Well(s). <br /> (Applicant Signature) �� f5 4i�Rr �N G o� 8it�F <br /> Business owner/Property owner <br /> (Please specify) OF GnvoGo <br /> fART'f ov�RSI,vG 7�{F oPE'� - <br /> Ben Chevien CV V1 RoAl <br /> (Print Name) "_��-� G,�,�GGS s 1F <br /> ATC Associates <br /> (Company Name) <br /> 25 Cupania Cir., Monterey Park, CA 91755 <br /> (Address) <br /> 805.496. 1217 <br /> (Phone number) <br /> GACDD\privt_Statl_t._BUSINESS OPERA'TIONS\REFERENCE\ENGINEERING\Brochure and Fonns\Revocable Permit Groundwater <br /> \A—t—i—1AT-11c A–- <br />