Laserfiche WebLink
San Joaquin CouutY �o I���'�11 �"ll r[.- SITE <br /> tal Health De�arft e`er <br /> Ea�z><oimnen MITIGATIO. <br /> 304 Eas,t_-%Teber A-'°eu'I.te:.3rd Floor.Stoc don.,C. ,� '� N05 UNIT IV <br /> •` (2t9)4615-3449 Fax. (2.09)469-3433-%F b:wv,*W_sj9PV-0r9.eh <br /> ENVIRONMENT HEALTH <br /> Well Permit Application PERMIT/SERVICES <br /> I+ION-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 1115 arrat!etre Standards of n doa On County�nvironrnental Health Department_ <br /> Appficati�rr is hereby made to San Joaquin County for a pernilh to cOnstrar;�andfor lnstaU fhe viork describe-cf. This apalicataan Is made a omphance v.1th an <br /> om <br /> ,�quv County Development Title.CtmPier F� 163-31.0-07 _ <br /> WELL Location 2059 Nary D1t•Ve <br /> Cross Strew_Tiii e Lev.15 _cAy—Btodkto3t_yip-.25?-Oo _Parte€#_ — <br /> PROPERTY 205.1IIa�.Y'[711ve City Stock L,p_�?5206 Phone# <br /> Owner Rose Cal LL.0 Adstress t510j 237671 <br /> Richmond �ip_ 4801 Lack 635387 PII12 <br /> 1081 Esser Avenue Citi__-- <br /> C-57 Contractor Prestcion Sampfllcl _Address_ Phones I510]233-32170_ <br /> ARCADIS Address. Marina Way South y Richmond Lir*_— <br /> Consultant i Sub Cntr Range Secton <br /> 42100093.0 Township <br /> GtS Coordinates:X_6477I31.4 Y—_____---WURI{TO BE PERFORMED; DESTRUCTION (choose type below) <br /> rIfi1EV1F 11M1IELL 1 BCIRIfJG (CP-k. 4OrP€7Q6c HYDROFUNCN.t IAE�tU AUGER,t7T3iEFi` 11 OVER-BORE. DIAM. <br /> J' OIL BORING# RV �!ROUT S E GROUT <br /> GROUT�ECIFICATIOItIS <br /> g WELL <br /> 0*Other <br /> COMMENTS: <br /> Types WELL <br /> IN STALLATRCIf[TYP£ CONSTRUCTION SPECIFtCAT10TIS <br /> 0 H£tLLO'3d1i 0 1+l DIS_OF BOREr1OLE_2_ I]dv1ULTIPLE CASIIJCS If MULTI-LEs.{EL. '1�fEELL CA.SIPE 131h <br /> MONITORING TYPE A CASING- D STEEL 9 PVC- 1]OTHER:____— <br /> ©EXTRACTION 0 AIR.HAMMERMRrVEN CASING THh:.I'NESS�— <br /> DMTEt OF GROUT SEAL-2-0 ft TREMIE TYPE TSI BE USED: 13AUGE'`S fl HOS <br /> VAPOR �MUD ROTARY Xio (NOTE: MAXIMUM FREE-FALL.DEPTH IS 30') <br /> AIR SPARGE/O70N-GUSH POINT{Grp or CPT)GROUT SPECIFIC ATEA D: 11'Yev —0 BOLTED TRAFflC BO? or 0 STOVE PIPE <br /> AWL BORING 0 HAND AUGER 30 it <br /> 0 OTt IER APPROX..BORING D--PTH_ rto (if YES,list speaficatidns in comment section) <br /> []OTHER: — CONDUCTOR CASING PROPOSED_ <br /> COMMENTS: <br /> i �GFEEMFEhT OR ENCROACHMENT PERMITS. <br /> NOTE: OFFSTE BORINGS REOU{RE ACCESS 3R I �N <br /> 4 �ORKI� FCURS JtTiCE REQUIRED <br /> certif that I have prepared this:application. and that the work will be done in accordance with San Joaquin <br /> I hereby Y <br /> s. <br /> County Ordinances. Rules and Regula I $, and all applicable California St�G�logist I ARCAUIS _---- <br /> T��Compa€r} <br /> gigrwf!x rOste_November 16.2005 �. <br /> Print _Ct�je ulard <br /> D=pA,0TUl=WT' USE ONLY <br /> SITE MAP IN KNIT IV FILE,ADDRESS: <br /> WORK FLAN DATED: <br /> Hate lasued <br /> As�caiai Accepted51. <br /> L �� /( Date Il Z Final Inspection By <br /> Date <br /> Grout,Inspect�n By Lame <br /> Dee r=tian Inspev ion By l (,0. <br /> COMMENTS/CONDYM"OfAS; �l S <br /> ACCOUNT ING ONLY: AIS FACS F2EC+D!BY DATE PERMIT <br /> SERVICE REQUEST� It4VOICE <br /> PE CODES FEE INFO ATvIOLiTdT REMITTED CHECK;? SR# !� <br /> 011 6 <br /> C-57_ <br /> WC--WAIVER— C`57 Letter of Authorization to Sian permit_-__Encroachment doc_,__ <br /> EED 29-02-001 <br /> G 117 rl1 <br />