Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT' '47 SITE, <br /> <br />600 East Main Street, Stockton, CA 95202-3029 MITIGATIO <br /> <br />Telephone: (209) 468-3449 Fax: (209) 468-3433 Web: NAAA..qi 2 6 24ENIT Iv <br />R E <br />Property <br />Owner -F.,- - 4° Address t -Z.e> t 6-1 • 1,1 <br />Address <br />Address s {31-••••-- City "" f'"'"-r`t n (-Phone <br />y - 1t 3 , Township Range Section <br />HYDROPUNCH, HAND-AUGER, OTHER) <br />Y 611-1-D, 2 -0' ••q'" <br />WORK TO BE PERFORMED: <br />NEW WELL/BORING (CPT, GEoPROBE <br />SOIL 130RING# <br />D WELL # <br />-OTHER <br />DEPTH OF GROUT SEAL <br />TYPE OF WELL INSTALLATION TYPE <br />\Iti MONITORING 26 HOLLOW STEM <br />P EXTRACTION 0 AIR HAMMER/DRIVEN <br />E VAPOR c MUD ROTARY <br />0 AIR SPARGE/OZONE 0 PUSH POINT (GP OR CPT) GROUT SEAL PUMPED! <br />0 SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS \--\ •-• <br />0 OTHER! C OTHER: <br />COMMENTS: <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS <br />1:2-0 tAtt <br />DEPARTMENT USE ONLY <br />- 1,2:•21) . <br />Date <br />Title/Company‹.--1-1 -c-•`). (4? <br />ARikr <br />DATE <br />No , 2525 P. 1 <br />WELL PERMIT APPLICATION <br />NON-REFUND <br />San Joaquin County for a permit to construct and/or Install the work described This application Is made in compliance with San <br />Title, chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />Assessor's <br />was Street 'NZ City 5-f-ac.-4-4-ci-- Zip '15.1-4- e> Parc& # 0 <br />COMMENTS' <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS <br />I hereby certify that I have prepared t Isit plication and that the work will be done I accordance with San Joaquin County Ordinances, Rules and <br />Regul tkrna,"aud I applicable Call rnia Owe. <br />...--7 <br />Print Name <br />SITE MAP IN UNIT IV FILE, ADDRESS: <br />efs. c‘. <br />SAN JUAL/UIN COUNTY <br />ENVIRONMENTAL <br />1311 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED HEALTH DEPARTMENT <br />City S ,L- zip q S Phone # ebe'41)1 f-C-oz <br />city LoJ,_ LIc# 1.-L0`P+Phone C1:-,D1)3C1 - 1615-a <br />GIS Coordinates: X 11 • "'c <br />r /2_ <br />CONSTRUCTIQN SPECIFICATIONS <br />CIA. OF BOREHOLEIO " MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIN <br />CASING THICKNESS € t4 TYPE OF CASING: 0 STEEL gPVC 1J OTHER <br /> TREmiE TYPE To BE USED 0 AUGERS 0 HOSE <br />Yea 0 No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br />( <br />APPROX. BORING CW:)TH <br />CONDUCTOR CASINO PROPOSED <br />72 BOLTED TRAFFIC BOX OR 0 STOVE PIPE <br />(if YEff, list spectEcatIons In comment section) <br />Signed <br />WORK PLAN DATED: (1./ie 1,) t•2- C.-7 (4 a r( -ti <br />APPLICATION ACCEPTED EY kv....ta ( DATE ISSUED <br />GROUT INSPECTION BY FINAL INSP CTI BYL <br />DESTRUCTION INSPECTION BY ,ci- , ,.4.A-02X• DAT g ic tio ; 1 <br />O <br />,i, <br />MMENTSICONDITIONS: /44'0 .-' ``="1 /%61-1.7k 4;191,vuLit&I 5t, ' i. /-:1 .f.:› • <br />AID # FAC # <br />RECNID BY <br />ACCOUNTING ONLY: INVOICE CHECK* AMT REMITTED FEE INFO PE CODES <br />7' SRW5S. <br />02_ <br />PERMIT/SERVICE # DATE <br />fA <br />_ Aug. 25. 2008- <br />Application is hereby made to <br />Joaquin County Development <br />Well Location 1-Z'-''va <br />4: <br />rl <br />/**-- <br />C-57 Contractor •.) <br />Consultant/Sub Cntr <br />(It-DEsTRUCTION (CHOOSE TYPE BELOvvi <br />OVER-BORE DIAMETER <br />PRESSURE GROUT <br />GROUT SPECIFICAT - Ion <br />1- —