Laserfiche WebLink
TYPE OF WELL <br />fJ MONITORING <br />a EXTRACTION <br />r VAPOR <br />?(AIR SPARGE <br />30:L SORNG <br />OTHER: <br />INSTALLATION Tt'PE <br />XHDLLOW S"r EM <br />f0 AIR HAMMERinRIVEN <br />g MUD ROTARY <br />ri POSH PONT <br />a HAND Al.!0::-."R <br />L. 4, • <br />0,7? <br />WELL PERMIT APPLICATION FCiRM <br />RECEMED <br />ENVIRONMEN1 i--.LAL <br />Ar:161i-fildn. is hereby made to San .ioaQw!-: County for a per,Ilit to constnict andlor install t?%e work described, :This- application is made-in compliance with San <br />nc pm; NON-REFUNDABLE PERMIrr EXPIRES i YEAR FROM DATE ZSUED <br />OCT 3 0 2-°t)1 <br />;,:-.- -n-i <br /> <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION (PHS4EHD) <br />304 E. Weber, Third Floor, Stockton, CA., 95202 <br />(209) 468-3449 <br />Joaquin County Development Title. Chz.lpter 9-1115.3 and the Standan:Is of Son Joaquin County Public Health .3erviceS, Environmental Health Division, <br /> <br />Ferwix, To sc.o `1* (oIS ( Assessar'S <br />WELL Location...3301 eci/Qtf tc... Alleit LA.0 Cross Street 1144 IrcIN Z.A. City ,4Stioc.,k ftly‘ Zip Parcel-4 ilIDg - /go -0 ,4 , <br />Al 1 c v II ell 11144, . /vjorrie‘trqp-5.5T1t13-phoneft_C_ <br /> . _ <br />FROPF_RTY Owne __"."1/4 ‘41"1/44-5, t r• Add re5^ r7 77 <br />-- ...1., _I_ <br />C-S7 C:ntractornt ScaL 0 (-. litt_.5 Addret S S(D32. (Dolce Cf.rc le city_corte, ziptSTio.#71751° Phonet(10 63- 11625 <br />s...:.t. 32. <br />c..onsui;alt / Sub 037,traCtOr eiflee-- Ripon Address 136'1 NMGobwet‘ _Oatity Per.i...Lie# <br /> <br />, Phone# c::.•7,) 7-32 ES <br />s Coor.r.lnates: X , Y . , TcwnShip Range l! <br /> <br />l <br />Section <br />l <br />I <br />aCc <br />SITE <br />MITIGATION <br />UNIT IV <br />WORK TO EE PERFORMED: <br />).NE/ WELL! BORING ( CPT, GECPROSE. HYDROPUNCH, HAND-AUGER, OTHER") <br />[3 SOIL BORING # SfRIMIPE*Iii <br />%WELL # SP -1 "') SP-13 <br />'Other: Gmut SpecifIcations: i— <br />S f=15_. -,e:1S_...) ,a_.;.C..c._..6CCI? sP—it P-13 COMMENTS - <br />['DESTRUCTION (CticiQs0 type below) <br />U OVER-BORE <br />a PRESSURE GROUT <br />(IC) "deef, <br />CONSTRUCTION SPECIFICATIONS <br />DIA. OF BOREHOLE g if MULTIPLE CASINIGS? p YES 0 NO WELL CASING DIA; <br />C,e,SINr7s, THICKNESS 5C3N 4° TYPE OF CASING: a STEEL %PVC a OTHER: <br />DEPTH OF GROUT SEAL 571, 32.' TRENVE TYPE TO BE user): fl AUGERS WHOSE <br />_7- GROUT SEAL PUMPEO7 elrfes C No (NOTE:ImAximum FREE-FALL DEPTH IS 30') <br />GROLiT SPEDiFICA.TIONS: Celine ftt <br />APPROX. BORING DEPTH CS' to 4/01 OLTED TRAFFIC BOX or a STOV5 PIPE <br />C:._-)NIDUCTI.IR CASING PROPOSED? It/D it YES, rst specificatiOns here): <br />3// <br />'COMMENTS: <br />NOTE: OFFSITE BORiNGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. <br />CALL THE UNIT IV ll$ti-FECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. <br />I hereby certify that I have preparad this application and that the work will be done in accordance with San JOaCitlin <br />County Ordi nc s, Rules a d Regulations, and an applicable California State Laws. <br />TitleiCompany SQKLo C.,9e010i CC oeycci--1. A ev,i- . /-) <br />SITE MAP IN UN:T IV FILE, ADDRESS. Li 707 Pact c <br />WORK PLAN DATED: " -2 1 <br />Applltztion Accepted Si <br />Grout Inspection Ey <br />D.-;struction insoection Ey <br />COMMENTS / COMMONS: <br />.1 <br />II ACCOUNTING ONLY: <br />i , <br />1 r PE CODES FEE INFO AMOUNT REMITTZ.:D CHECK # REC'D BY 1 DATE RERMIT 1 SERVICE REQUEST # jr;:iVOICE , ____ <br /># <br />Signed x EBBW 4 <br />Pint Marne 0.9 cVe Ca/44;C t <br />DEPARTMENT USE ONLY <br />Date issued, I r;11 I O. I Area <br />Fins' Inspection By Data <br />AD0 <br />C-57 Letter ot. Authorizalion to sir permit : Encroachment doc 9 2ft u C-37 WC -WAIVER