Laserfiche WebLink
FILE COPY <br /> jan Joaquin County <br /> Environmental Health Department 0A1SITE <br /> N' K <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 MITIGATION <br /> (209) 468-3449 Fax: (209) 468-3433 Web : www.sjgov.org/ehd <br /> Foa� p Well Permit Application gfJ/-�� 2007 pA <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED I" t � '1'r`H P Y <br /> Lt4YIkONftENTAL <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described . This applicaAl.r ilT r�rg, aP6e}tk{�,h�San <br /> Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Depart men <br /> 1201 South Center Street Assessors D 03 2 <br /> WELL Location �j Cross Street French Camp City Stockton Zip Parcel# JL {'J J <br /> PROPERTY .i / O , 7' r "" —/C ' !/i/Q / <br /> Owner Roger Huckins Jr L Address3436 Admiral Drive City Stockton Zip 95209 Phone# ! 6 <br /> C-57 Contractor Mitchell Drilling Address 7900 Myrtle Ave Gily Eureka Zip 95503 Li,# 672617 Phone# 707 - 444 - 9040 <br /> Consultant / Sub Cntr Adv GeoEnvironm�entalAddrreessssp837 Shaw Road City Stockton Lic# Phone# 467 - 1006 <br /> �Ca <br /> GIS Coordinates: , ,4 : 1Z/. Gau 3 , Township Range Section <br /> WORK TO BE PERFORMED : <br /> gNEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND-AUGER, OTHER*) g DESTRUCTION (choose type below) <br /> g SOIL BORING # g OVER-BORE. DIAMETER <br /> $ WELL # EW - 1 through EW - 4 g PRESSURE GROUT <br /> a *Other GROUT SPECIFICATIONS <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION aPE CONSTRUCTION SPECIFICATIONS <br /> g MONITORING ® HOLLOW STEM DIA. OF BOREHOLE 10 g MULTIPLE CASINGS g MULTI-LEVEL WELL CASING DIA: 4 " <br /> EXTRACTION g AIR HAMMER/DRIVEN CASING THICKNESS SCH 40 TYPE OF CASING: g STEEL ff PVC g OTHER: <br /> g MUD ROTARY DEPTH OF GROUT SEAL 30 / 110 TREMIE TYPE TO BE USED: giAUGERS g HOSE <br /> g AIR SPARGE/ OZONE g PUSH POINT (GP or CPT) GROUT SEAL PUMPED: g Yes ONO (NOTE : MAXIMUM FREE-FALL DEPTH IS 30') <br /> g SOIL BORING g HAND AUGER GROUT SPECIFICATIONS Portland Cement <br /> g OTHER:_O OTHER APPROX. BORING DEPTH 50 / 120 g;BOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> CONDUCTOR CASING PROPOSED NA (if YES, list specifications in comment section) <br /> COMMENTS: 3 Ground Water Extraction wells , two to 50 feet bag , one to 120 feet bsg <br /> NOTE : OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS . <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinan� ey, ging; and egulations, and all applicable California State Laws. <br /> Signed /��(r "//�"•✓ Title/Company Vice President <br /> Print Name Robert Marty Date 3 - 5 - 07 <br /> DEPARTMENT/ USE <br /> ONLY ? <br /> SITE MAP IN UNIT IV FILE, ADDRESS : �� / c�ww[ <br /> WORK PLAN DATED : L <br /> Application Accepted By Date Issued — Area &I, <br /> Grout Inspection By Dale Final Inspection By ate <br /> Destruction Inspection By Date <br /> COMMENTS I CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK # REC'D BY DATE PERMIT I SERVICE REQUEST # INVOICE <br /> so Nt w >= 3 25 3 S SR# DD 9D5 <br /> C-57_ WC= WAIVER_ C-57 Letter of Authorization to sign permit_ Encroachment doc N <br /> EHD 29-02-001 <br /> 6/22/04 <br />