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--Rfi/18/2002 13: 36 20946P"433 FIFTH FLOOR, PAGE 02_ <br /> , 1512092 13:01 2094633433 FIFTH FLOOR PAGE 03 <br /> WELL PERMIT APPLICATION FORINT SITE <br /> MITIGAT1bN <br /> SAN JOAQUIN COUNTY UNIT IV <br /> ENVIRONMENTAL HEALTH DEPARTMENT(EHD) <br /> 304 E. Weber, Third Floor, Stockton, CA., 95202 <br /> (209)468-3449 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Dpllcation is hardy made to San Joaquin County for a permit to construct ancilor instal!Vm work descri-ed. This eppfiration Is made in comp Dance with San <br /> ;ac;uin County Development 7110,Chapter 41115.3 and to Stanch s c San Joaqul, Coungr Er+vUon'pe, al H 1h DepartrnenL <br /> 3 R I G 1 ` �yy�►� 1.b�141d �5 N- 'tu� h,. ssors <br /> �LLJ_ctlttert r��s W � JAjq� ,tet C,'ty ZP Pa=l# <br /> ROPEM-Y Dwne," Z7//5 , {ltAtidrass 5'IU•ltJ� t +t i'i• GK�f c� V" C 'Ia Phone# / l <br /> C-57-5i Contra=lr' '✓. 0 I /dJ cress, <br /> X r�2 J/J/ ZL cfF �i�� �honC�( 7 OT I -17 <br /> onsuttarr 1 Sub Cv:nmcto '-s N rt'v I�l Adrr s S (1 k1KM r� i Clry����Jc ��Phon �� <br /> IS Coordinates:X Y Townshipza-E—_ Range <br /> !ORK Tb BE PERFORMED: <br /> 'NEW W_LL1 BORING(CPT,GEOPROSE-HYDROPUNCH, ND•AUGC TRERn C GESTRUC M0N(choose type below+) <br /> RSOILBORING;4 Id D OVER•BORF <br /> PRESSURE GROUT <br /> 7 her• -- Grctlt Soec4cation <br /> OMMENTS: <br /> YPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS Q ' <br /> 1,40 TORING [}HOLLOW STF-m DIA.Cr SORE-IOL E r MULTIPLE CASINGS?E Y"eS )<NO WELL CASING 01,k-�h <br /> EXTRACTION 11 AIR HAMMERORIVEN CA51NG TI-tCXNESS TYPE OF CASJNG: a$-FEEL 0 PVC Q OTH"R tz <br /> VAPOR. ❑MUD ROTARY DEFT H OF GROUT SIAL - _TREMtE ME TO 5F USED. 0 AL*ER3 HOSE <br /> AIR SPARGE a PUSH POINT GROUT SEAL PUM?EI]t Il Yes !] tNOT E; MAXIMUM FRET* ALL EPTH IS 30') <br /> "SOIL BORING HAND AUGER GROUT SPiwCIFICATtONS: <br /> OTHER:_ n OTHER APPROX BORING DE Pil i n BOLTED TRAFf71C BOX or 0 5TOVE PIPE <br /> CONDUCTOR CASING PROPOSED? (If YES,list specffi tions herar ( � <br /> .OMMENT'S: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. <br /> CALL THE UNIT IV INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. <br /> hereby certify that I have prepared this application and that the work W1111,be done in accordance with San Joaquin <br /> .ounitiy Ordinances, Rules and Regulations,and all applicable California State Laws. <br /> igneti TctPlComparly ��� L <br /> Tint Name q - MENoat= <br /> DEPARTT USE ONLY <br /> ITE MAP IN KNIT IV FILE5ADDRESS: <br /> YORK PLAN DATED: r�i, /ZZ 1 7 <br /> pplication Accepted By ( Oate Issued A=F� <br /> .mut Inspectlon By Date Final Inspection By Bate <br /> estruc�on Insaection By Cate <br /> 'OMMENTs i CONDmONS: <br /> r.CCOUNMNG ONLY: AID# rere I <br /> ''S CODES FEE INFO AMOUNT REMrT ED CHECKIP REC'D BY DATE PERMrr t SERVICE RF-QUEST# WVOfCE <br /> c=9So Re 6030--0 <br /> 1/25/02 <br /> -57 WC -WAIVER_ C-57 Letter of Authorization to sign permit Encroachment dor. _ <br />