Laserfiche WebLink
SAN f QAQUIN Environmental Health Departmmit <br />COUNTY <br />Greotness grows here. <br />SITE MITIGATION WELL & BORING PERMIT APPLICATION <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />24 Hours Advance Notice Required For All Inspections <br />CALL (209) 953-7697 For INSPECTIONS <br />Application Is hereby made to San Joaquin County for a pertn(t to construct and/or install the work descri <br />bed. <br />This application is made In compliance with San Joaquin County Development Title, Chapter 9.1115.3, and the San Joaquin County Well Standards, <br />Job Address 206 N. Sullen Street City/State/zip Stockton Phone (2 Boo <br />Cross Street E. Channel Street APN - 139-260-030 <br />Proporty OwnW d5*4rF" jpi'o m f+4 "13 0711ye!9+ Cyq" , L4L L Phone 045 <br />Address 1+} 30 'R 1 p✓1d✓'0. t61uce* Clty/statelzlp L 1A WSrA . Lo9 �iV (0 at <br />C47 Contractor Confluence Technical Serv <br />ices, Inc. Llcenae# _ <br />Address 6821 BIT Street city/statelzip <br />Consultant/Sub-Contractor Luke Castle License# <br />Address 188 Frank West Circle <br />1035255 <br />Rio Linda/CA/966373 <br />CA PG 9945 <br />City/Stetel2lp SlockloNCA/96208 <br />Phone 918.759.3512 <br />Phone 209.636,7379 <br />CONSTRUCTION WORK TO BE PERFORMED: •Note: Offsite BodngsANells Require Access Agreements or Encroachment Permits <br />TYPE OF WELUL30RING NUMBER INSTALLATION <br />TYPE CONSTRUCTION SPECIFICATIONS <br />❑ MONITOWNG ❑HOLLOW STEM BORING DEPTH ua 1080' ❑BOLTED TPAFFIC BOX ❑STOVEPIPE <br />❑ EXTRACTION(VaWAYalur) O MMMERIDRIVEN DIA, OF BOREHOLE 2.25' D MULTIPLE CASINGS O MULTI-LEVEL WELL CASING DIA <br />D SOILVAPORPROBE D MUOROTARY CASING THICKNESS TYPE OF CASING: OSTEEL DPVG D OTHER <br />es <br />0 SOILBOHING 7 0 PUSH POINT(OP/CPT) CONDUCTORCASING ❑YDNo BWa Diu: a: <br />CxhigaN: <br />D INJECTION to sosoa 0o O HANOAUGER GROUrSEALDEPTH TREMIETYPETOBEUS50: ❑AU9E ❑HOS PIPE <br />O OTHER D OTHER GROUT SEAL PUMPEOI ❑Yes ONo ole: Maxinum Fmefal Depth is 30 FU • <br />WEWSOILSORINGIDs DP4 through DP -7 GROUTSPECIFICATIONS Neat(lemen m <br />t <br />DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: TCHECKALLTHATAPPLYI <br />#W[I ` S 2 NCOr4YrK� <br />ELLSTO BE DESTROYED OVER -BORE DIAMETER of _inches to depth ol_ feet <br />WELL IDs ❑ PRESSURE GROUT To depth of _ feel below surface <br />PECI <br />GROUTSNCATIONS [3 EXPLOSIVES From to feel below surface <br />Sen Joaquin County Ordlnenee <br />end all other applicable CalHomla laws. <br />Signed �� �� Title/Company Gtr <br />Print Name Luke Castle pato 7/29M022 <br />Application Accepted By:� <br />Grout Inspection BylDates: <br />Destruction Inspection BylDates: <br />Far-IIIN7Rim Infnvmatinn <br />.Z <br />18Su8tl: a /� Q f � Z Z <br />FA Neme <br />T-- � <br />Mitlgaaal WBII Penal Applireem <br />