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junJUN. 1. 10013 9:41AM WOBiam siowik 559638 . 655 NU. 111J t, 1P•e <br /> I STANISLAUS COUNTY OEPARTMENT OF ENVIRONMENTAL RESOURCES <br /> 3800 CORNUCOPIA WAY, SUITE C. MODESTO, CA x.5358 <br /> (209) 525-6700 <br /> Application For Monitoring Well Construction Permit <br /> Mgftrmh Expires l Year From Daft Lmxd) <br /> Applkation b herrby made to the Stan'i clans Cotmty Department of EavirnnRKwW Reaourm for a p+er=IC to candect the pork <br /> hertis deirrUwA pkage notay the aaraardaw m2seria s Aivhwu At lust 48 tura hot advance er starting the xork <br /> IFACri T Y/8TIE NAME x S sttEbm <br /> ]OB ADDRESSILOCAJION F x. -%� t <br /> CTTYISTATFmP 4�P �S A U .: I t n . ?r( o _.De's-6 " f 3 <br /> OWNERS NAME 2 i r f, v ' ADDRESS 3 rn er` ,q ,K <br /> C �t/5'rA'r> .I� �IA� L 5 3 r P�14 z �r -r3�SA <br /> DRi j,WG CON-MACTUR RSj DEjji,96 C-57 LICENSE NQ6 2. a <br /> WOROAANS COMP i t Ft , D,-'l. i- .i 24O6 CONTRACTOR P1 tONE - ->ej° <br /> . ,sq k <br /> if ac0auearo�of the VCRs)will fotbw methodok�g`d�► *work gtnn on ble s,.Ih the otTmvittamntxttal Reno+tr'tes, <br /> plt m 't the title of the vvotl< i and dace C a <br /> A� -Ve lint. su �'�' <br /> TYPE OF WORK(Check): 1? W L.(Chuck): <br /> D Install New Well GToUndwaW MorsitArWSaMPrM9 <br /> Number of New wells Ct Groaadwater RX11=lon <br /> Install Tt tatary weR(ex.HydryptmCh) o Floid Vection <br /> Ntmtbec of a 0rarr ells__b_ _-. ° °thee . <br /> We#1 Destn=fion 1t±IET.t�On OF DRU LING Check <br /> 'Number of Wells To Destro (Check) <br /> ❑ uiter Lnf:ytznatiots r- h j 4" Hollow 5��--� <br /> �--tX•�Dca 5B�33 Other <br /> C©NSTRuclnoN�S��iCAT ONS: <br /> S D�iametex DISTANCE TO NE.UWST: s <br /> Cain T D�t�and Cxauge ' +� Domestic Supp14 Wed' �2.5b _ f <br /> To Cvmu*,Ktcr 2r: Sewer Lbies or Septic:TanirfI.eaah Feld <br /> Depth <br /> of Death ofWeninw w Other SiRock sur�Strtacture 7 <br /> i?epth of Screctteti Itltetvsl <br /> Depth ofFdter Pack J`d <br /> iSIE�UI :T=Sizu of Filter pRa Macraw <br /> � Snt <br /> Size NA <br /> ' Depth and Type of Transitioai SealWell l qnb <br /> Depth sad Type of Grout Seal 10 aux*dexxtfim�f u3*W ial oh=nC+�psocadn—ra <br /> A600�_ t4 � <br /> �bt1l y r -f re Pd <br /> ' IV© Ade ailed and smaed site pian with p dn-Wn locations„a1A proposed weJ1 constrycdo t <br /> diegiaass�INUST be attachsd to[bis canon. <br /> F Y CRUIFI Y THAT I HAVE PRF3'ARFD TW5 APPUCA DON AND THAT THE W01Y,WILL BEDOM�l <br /> acY_'-(y�tiD•Jt_NCF WITH-ME FROVISIONS OF THE LAWS OF THE STATE Of CALl1 ORNLik,TM ORDWANCES OF THE <br /> COUNTY 4F STANL'4�IAUS,,AND 7E RL S AND REGULATIONS OF TBE SFAKM AW Wkftrl f Dt-xAx"i i Mar+0V <br /> ENVIR <br /> SIGNED Dun: <br /> ' Oucter or,Atrihartzcd restntative <br /> Psrurit t7 permit Actrietl By: <br /> Uat�-: <br /> DATE ISSf1ED: <br /> baspected Bp: Ft Paid- Yes%�No Amount�.Q <br /> Date.- - <br /> 4-013-58 <br />