Laserfiche WebLink
A?FUGALIU Ul4 Vitillrvmr riiii <br />SAN MOM cooly( Fusuc HEALTH SERVICES <br />ENVIRONMENTAL HEALTH LIIVISI0b1 <br />doomismomesprigpremenlIWI., STOCKTON, CA 562O1.382 <br />iu <br />Application is here by made to the San Joaquin Cut:icy for a permit to construct and/or install the woreZtribed. This application is <br />made in compliance with San Joaquin County Develtpment Tittn, Oapter 9-1115.3 and the standards of San Joaquin County Public Health <br />Services, invirormental Health Division. <br />Job Address/or APR: 5400 PACTFTC Avenue <br />Address <br />lags.; 1000A Ortega Way ucl 606348 <br />Address Monier Park Place041720904 • Ph orle 707/374-2815 <br />Pin vi <br />..4 MONITORING WELL X a OTHER <br />GEOPHYSICAL .ELL * .0 SOIL GORING <br />CROSS-CoNNECT REPAIR il VAPOR .EXTRACTION LEL!. g \FQ44-6 <br />DEPTH PUMP SET Fr. FIRST WATER L=VEL to VEW-13 <br />• <br />comsTRucnoxSPECIFICATIOMS <br />1. <br />INDUSTRIAL 0 OPEN SOTTCM DIA. OF WELL EXCAVATION 0" <br />DCMESTIC/PRIVATE :..1 Guys'. PACX/SIZE TYPE OF CASING/STEEL/PVC PVC <br />J8Lj/)JNJ PAL 0 DRIVEN DEPTH OF GRCUT SEAL 30-5571.4-2 <br />G Ila OTHER GRCUT VcAL INSTALLED SY NT A W <br />GROJT SEAL P4)PED:4)4re: POW <br />60' LOCXIRG CHESTER BOX/S.OVE PIPE <br />PROPOSED CONSTRUCTIONIDZILING METHOD: MID ROTART AIR ROTARY AUGER X oARL <br />I hereby certify that I have prepared this spot:cation and that the work will be done in accordance with San Joaquin County Ordinances,' <br />State Laws, and Rules and Regulations of the San Joaquin County. HOT* owner or licensed agent's signature certifies the 1oLlowin4: "I <br />certify that in the performance of the work for%nich this permit is issued, I shall root enaloy persons subject:to-LORXMAIVS CONPENSATION: <br />LW'S of California." Contractor's hiring or sub-contracting signature certifies the following: ' I certify that in the perforsance <br />oi the cork for which this permit is issued, I ;:tatl employ persons subject to Lr,R01AN 1 S CCMPERSATICN Laws of California." THE APPLIC:iXT <br />MUST CALLTA9URSIN ADVANCE FeR-Cfr7DOUIRED ILSJECTIOXS A712091084423. Complete drawing at lower area provided. <br />ew <br />Signed X er-J.A1A441 Title 5..P./YttelL CC11411-, <br />30 F. WEedi 45"*.t.Fieok OR <br />moluas=0113ABLY. PERMIT EARES R FROM DATEISSUE74 <br />Montgomery Ward <br />C=tractor Environmental Audit, <br />St.t Contractor V &_Tli Drilling <br />city Stockton <br />5400 Pacific Avenue <br />Parcel Site/AP - <br />Phone <br />ph,,m#714/7736227 <br />714/632-8521 <br />TYPE OF WELL/PUmPl 41 NEW LiELL <br />0 DESTRUCTION <br />INSTALLATICX <br />0 Mew Q Repair <br />REPLACEMENT LILL <br />CUT-OF-SERVICE WELL <br />LELL SYSTEM REPAIR <br />H.P. <br />(TYPE OF PUMP) <br /> <br />INTENDED USE Trf OF WELL <br />ACNITCRING <br />APPDOX. DEPTH <br />(1\. <br />DIA. OF WELL CASING 1 "/ <br />sPEcuicAricw <br />GRCUT GRAND NAME <br />CCRCRETE PEDESTAL BY DRILLER: es C No <br />DIA. OF ccucucToa CASING <br />OTHER <br />Date/Ifrr <br />I I I <br />ocs3-3-91/Gtds <br />GI 14 si3 <br />I I <br />A. <br />DEPARTMENT USE ONLY <br />Grout Inspection Sy Date Puma Ins :ion By <br />Destruction Inspection ay Date Comments: 1 y 071 77 .7- • <br />ILA, ..41•••••• <br />*Cr a;• <br />Application Accepted By <br />H I ILL. <br />0.t2 •-•9f A ,ave <br />Date