Laserfiche WebLink
DEPARTMENT USE ONLY <br />lea-a.c..-4- <br />2 • 5•OS <br />SITE MAP IN UNIT IV FILE, ADDRESS: <br />WORK PLAN DATED: <br />Date Issued <br />Final Inspection By <br />COMMENTS / CONDITIONS: <br />ate <br />Date <br />Application Accepted By <br />Grout Inspection By M L <br />Destruction Inspection By <br />Area da,(1 <br />ezP- b <br />Signed x <br />6-6F-42/147ar- Prin <br />San Joaquin County <br />Environmental Health Department <br />00 East Main Street, Stockton, CA 95202-3029 <br />468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />ORIGINAL <br />SITE <br />MITIGATION <br />UNIT IV <br /> <br />7 2008 Well Permit Application <br />.._ NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />71' <br />Applicationi-ber'eby .niade to Sanjoa' quin County for a permit to construct and/or install the work described. This application is made in compliance with San <br />Joaquin Cour4-Developineni Thle Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />Assessors <br /> <br />WELL Location 1Z-51- WeSr 4v9, Cross Street 5; UniriN4 £0 City Mikarerk Zip /133 Parcel# 200 - 150 <br />PROPERTY <br />Owner 53 V4L4C1 P. CAddress P, 0, aox Z5Zq City rn4A/Tet-4 Zip c/53,56phone# <br />City /4.42;rre4e2 Zip 71553 Lic#11.7763-Phone# (ci L5) 33 -5100 C-57 Contractor 6110-4-C- 6,--L61-6- Address 95V Iroivf 124, <br />Consultant / Sub Cnt1Gw95,7)64 -eck,elsi th.950.-Address2a10 411.17/A/Cry Ot . City tcrieVAi.ir Lic,# Phone# (<10‘77 -3q0)- <br />0110 <br />.Pv6. - 111 , z36 3 , Township Range Section <br />WORK TO BE PERFORMED: <br />0 NEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND-AUGER, OTHER*) <br />O SOIL BORING # <br />O WELL # PRESSURE GROUT <br />0 *Other GROUT SPECIFICATION <br />COMMENTS: <br />S Atelfwr <br />Aiat,{ -4A4**-dcl7e0( -1t4.4- A4474 —/X-"diogad <br />INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />O HOLLOW STEM DIA. OF BOREHOLE `g " a MULTIPLE CASINGS p MULTI-LEVEL WELL CASING DIA: <br />El AIR HAMMER/DRIVEN CASING THICKNESS 90,5 TYPE OF CASING: a STEEL A'VC U OTHER: <br />MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: a AUGERS El HOSE <br />PUSH POINT (GP or CPT)GROUT SEAL PUMPED: a Yes U No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br />0 HAND AUGER GROUT SPECIFICATIONS <br />U OTHER APPROX. BORING DEPTH I] BOLTED TRAFFIC BOX or 0 STOVE PIPE <br />CONDUCTOR CASING PROPOSED (if YES, list specifications in comment section) <br />COMMENTS: &5i72.j 3 64.,,,n wat.s 4.4 50.rt v44672, Ae.a6c-s <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordinapes, Rules an ulations, and all applicable California State Laws. <br /> Title/Company P40.:76-Cr- c2r,R1414757/Cefrse.5Ze.-,4 - eale76 <br />Date / -We> 7- <br />ACCOUNTING ONLY: AID# FAC# <br />PE CODES FEE INFO AMOUNT REMITTED CHECK # REC'D BY DATE - PERMIT T # INVOICE <br />RI 2/- LO) Sr " ' 30in c.A 7-.17. 653 1 5' / , <br />C-57 WC -WAIVER <br /> <br />C-57 Letter of Authorization to sign permit do <br />ti ? 7-00-.7 GIS Coordinates: r A , . . . <br />115 -- <br />) A ESTRUCTION (choose type below) 6,//#54 u.,1 <br />'OVER-BORE. DIAMETER <br />TYPE OF WELL <br />Ag[V1ONITORING <br />O EXTRACTION <br />XJAPOR <br />O AIR SPARGE/ OZONE <br />O SOIL BORING <br />O OTHER: <br />Sc 4rP4C1tc/7-9 “,Cieet-Pe:4i.1 <br />C) <br />EFID 29-02-00 i WEB <br />9/11/2007