WP0043068 - Laserfiche WebLink

Home Browse Search

SAN JOANN � � t c , � �9o � © � rrt� � � � C � � Q � G� Depar� lr� rr� � ntr - - 00UN T Y -- 1p, , ;' ' Greotness grows SITE MITIGATION WELL & BORING PERMIT APPLICATION NON - REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 21-1, f=lours Advance Notice Required For All Inspections CALL ( 200 ) 9534697 For INSPECT IONS Application is hereby made to San Joaquin County for a permit to construct and/or install the work described . This application is made in compliance with San Joaquin County Development Title , Chapter 9A 115 . 3 , and the San Joaquin County Well Standards , Job Address 4522 East Marfargoa Drive City/State /Zip Stockton , CA 95215 phone Cross Street None , near Clark Drive and Mariposa Road APN 179 -220- 13 Property Owner* William Black Phone Address 4522 East Marfargoa Drive City/State/Zip Stockton , CA 95215 C - 57 Contractor Neil O Anderson & Associates Inc . License# 669004 Phone 913 - 599-6886 Address 10841 S . Ridgeview Road Clty/State/Zip Olathe , KS 66061 Co nsultant/Sub - Contractor Terracon Consultants , Inc . License# Phone 209- 367- 3701 Address 902 Industrial Way City/State/Zip Lodi , CA 95240 CONSTRUCTION WORK TO BE PERFORMED : * Note : Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL /BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ® HOLLOW STEM BORING DEPTH 15 to 70 ft ❑ BOLTED TRAFFIC BOX ❑ STOVE PIPE ❑ EXTRACTION (Vapor/Water) ❑ HAMMER/DRIVEN DIA . OF BOREHOLE 6 Inch ❑ MULTIPLE CASINGS ❑ MULTI - LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING : ❑ STEEL ❑ PVC ❑ OTHER ® SOIL BORING 3 ❑ PUSH POINT (GP/ CPT) CONDUCTOR CASING ❑ Yes ❑ No Boring Dia : Casing Dia : Casing Depth : ❑ INJECTION (Air sparge , ozone/ ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE ❑ OTHER ❑ OTHER : _ GROUT SEAL PUMPED? ❑ Yes ❑ No (Note : Maximum Freefall Depth is 30 Ft) WELL] SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED : DESTRUCTION METHOD : (CHECK ALL THAT APPLY) It WELLS TO BE DESTROYED ❑ OVER- BORE DIAMETER of inches to depth of feet WELL IDs ❑ PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑ EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑ AUGERS ❑ HOSE ❑ PIPE ❑ MUSHROOM CAP ❑ 3 feet below surface or feet below surface if > 3 feet COMMENTS : 1 hereby certify that I am authorized to complete this application and that the work will be done in accordance with San Joaquin County Ordinance Codes and Standards , and all other applicable California laws . Signed �� `pal Title/Company Professional Geologist / Terracon Consultants , Inc . YY � �✓'�ii.z Print Name Tony Mikacich r ( Date February 18 , 2022 DEPARTMENT USE ONLY Application Accepted By : JEFFREY WONG Date Issued : 3 / 11 / 2022 Grout Inspection By/Dates : Destruction Inspection By/ Dates : ZeLl Facilit /Site Information FA Name Proposed Distribution Center FA Address 4522 and 4600 Marfargoa FA# 0027047 PR# 547551 FA PE 2950 WP Reviewed By JW Work Plan Date 2 /22 /2022 ❑ C- 57 G57 Authorization for Other to Sign Permit ❑ Worker's Comp ❑ Worker's Comp Waiver ❑ Encroachment Permit ❑ Access Agreement ❑ Lead Agency Approval I MFR COMMENTS/ CONDITIONS : Submit copy of report/testing resLllts to EHD per SJC Well Standards 13 . 7 . 2 WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV' D BY DATE WELL PERMIT# INVOICE# Permit 2905 313 1 $ 152 x 3 456 CC JW 3/2 /2022 WP0043068 186� Rfir�aze AIII Avenue � 35tocMon , California 95205 1 T 209 468 - 3420 1 F 209 4e4 = O 'f3 9I www. sjgov . org /ehd EHD 2M1 06-28 -21 Site Miligaflon Well Permit Application