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Mar-20-02 12:38P VIRor"�x, INC. 510 568 7679 P.03 <br /> U3/20/2002 13:04 20944'�1133 FIFTH FLOOR PAGE Eta <br /> r»r ate,coal u�:,b L074beR'» r 1r n fLLtLJK �' rraue n� <br /> et1-Il-WEL_L PERMIT APPLICATION FORM SITE <br /> >� SAN JOAQUIN COUNTY MITIGATION <br /> 02 �� mA 2, 'ENVIRONMENTAL. HEALTH DEPARTMENT (EHD) UNIT IV <br /> 304 E. Weber,Third Floor, Stockton, CA., 95202 <br /> � ' L (209)468-3449 <br /> Nop-ammDANXILE PER ,YEAR FROM 2M*SUED <br /> )pllcatlon is hcreby mads to son Joaquin Counpr fora permit to oonstruatan or install tM work described. Yss applkafan is mads In con+Plienoe with San <br /> -equin County DevolopmeN r0A,GtQpW 9-7115.3 and the Standards or Sun los quin Counllr Environmantel Haelth DopaWnont. <br /> Alves <br /> �kiw� zc palmw_ S-1I-0-0 <br /> �Location�t15i�e-x}501 N. I�e�15�1�i hes <br /> A v� t.ross street�asen�oyue 1.•� city .....�. 4 <br /> 14220 S.W Cart7t y?WAt 'R3. <br /> zoPERTY Owner -7-�Icv�jr�� Addf9= Td i tt, �L o Cky�ot=n hND Z{p9�-a-0 t'hotlelt 7409-�h'2`I'8'f6b <br /> 5!CorkracyorU ✓D4&J6 Address,Z1110 Adarr\S i�1t�City 1 ` 7p� 7LIcW7059-.1Phom# 516-16=:- 746-7L <br /> onsukant 1 Sub ContrAaor 11 Co 2P. Address H OD5 Por4 Cl�l L t) Lade t3 k'12 Pho,+eu 42 26=3•`I89 8 <br /> M Coordinates:X Y Tawrrlshtp Reh9c Snootier <br /> K TO BE P <br /> HEW W EU-1 BORING(CPT.GEOPROSE.HYDROPUNCH,NAND-AUGER,OTHER') 0 DESTRucnoN(Choose type below) <br /> g$OIL BORING W A Q OVERBORE <br /> WELL TE M w-t 0 PRESSURE GROUT <br /> �t6er: Grout 8paelflmlionx <br /> OMMENTS: <br /> rPE gjFL INSTAAA AT1QN TYPE rAt smS ewMeTlONS <br /> ITORING LLOW STEM DIA.OF 60REHCLE MULTIPLE CASINGS?D YES � WELL CASING CIA: 2 n <br /> EXTRACTION (a AIR HAIWM"MRIVEN CAS 413THICKNESS 0.01-0 ---TYPE OF CASING: E STER PVC ()OTH <br /> VAPOR o MUD ROTARY 0ffPrH Oiv0ROLJT SRAL� 2'' TREMIE TYPE TO EIE UrPID: '0 AUGERS P"OS`c <br /> AIR SPt1RGk 11 PUSH Poltrr GROUT SEN.PUMPED: oyes ON* (NOTE:MAXmUM FRIES-FALL DEPTH 13 307 <br /> �O1t.60RING 11MAN DAUQER GROUT SPECIFICATIONS; 'i'2�+b �t<o� <br /> OTHER: Q OTI-4M APPRCIX.BORING DEPTH TED TRJB:RIC NOX• or Q STOVE PIPE <br /> CoNCV07M CASING PROPo56D? (if YES,Gat apedticobwa hero): <br /> :a1dmENT3• � - 'f a 50•F{ 6!4 4 ?ym ridyj-4:4 1. Sn_ U-:-- <br /> a W <br /> _NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. <br /> CALL THE UNfr IV INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. <br /> hereby c"fy that I have prepared this application and That the work will be done in aocardansm with San Joaquin <br /> :ounty ordinanam,hulas and Regulations,and all applicable Calrtornia state LAWS. <br /> lgned <br /> riot Name 1 {2. tDL \ TL- Dale J 6 <br /> DEPARTMENT SE ONLY <br /> ;ITE MAP IN UNIT IV FILE.ADDRESS: <br /> YORK PLAN DATED: ( _ <br /> pplkzUon Accepted 86F Lg^� "�` .. oats Issued �L1 Z p,.e UPy. t- <br /> rout InspeaSon By Gate Flnal Inspedon Uy DaleE_ <br /> lesyuc Ian InspecVan By Dale <br /> :OMMENTS I CONDITIONS: <br /> ACCOUP1 MO ONLY: ARX car-* <br /> pe COO=S FEE INFO AMDUWr REMITTED CH$CK O RICO BY DAM PEPMFT/SERVICE REQURSTO JNVOICC <br /> X56) L� 1 4-1-1- LL/±_ sR ?-15 2 <br /> 57 WG=WAIVER C-57 La"er of Authorization to Sign permit_„•_,Encroachment doc— 1/25/02 <br /> 03/05/02 'TUE 09:39 (TI/RX NO 5404] Q003 <br />