Laserfiche WebLink
WELL PERMIT APPLICATION FORT I <br /> MITI GA110N <br /> SIGN JOAQUIN COUNTY - UNITIV <br /> ENVIRONMENTAL HEALTH DEPARTMENT (EH131) <br /> 304 E. Weber, Third Floor, Stockton, CA., 9520 2 <br /> 09 r DEC s PM 3: � (209)468-3"9 ° <br /> N10"IE=FUN13AIgt�P=RMrr FDXPlRES Y YEAR FROM IJAIF-FSSIl�1.1 <br /> WrIcabon is rteseby made to San Joaquin Coumtyior a permt to construct andfa;vmW#1e work desenbed Thin a_pficabon is made In eo npitance wdh Sara <br /> oaqum County DewelopmentTdte,Chapter 9-1't 15 3 and the Standards of Sar 4*14 �n nty Er}mWar rental Haalth Department <br /> Cf~o'ki- eulCouAssesso's <br /> &FELL.t..0a lon �9 2] C oL Sine c��,Clty .o D a:, 93 Parcel# 'd55^32 p-19 - - -- <br /> 2RCWERTYOwner Lc, 40off Addramir-�-.--iA& /& GtyI&.ZJp�S.' Phone# 1-% -367 30 <br /> :a7 Cont Bdnr , ,- Address S �•/ C13y - tXir�n �s _L,c# �7Phone �s� f ZO L <br /> :nnsutbrrt!Sub Carr. ,F f Address j37 SSRw RD City�_+�t�r „� g PtmnE# a� {f 7-1, r3 6 <br /> its 1040rdina5es-X 'Y _ l'awnsttlp Range Se fionm- <br /> gORK TO BE.PERf0aMEn <br /> NEW WELL!80RING( GEQPROSS,HY 0PUNCH,HATND-AU [13i# '� Et DESTRUCTION(,:home type below) <br /> pll_aoRlrlts# K 4 l Y� ave P-aor <br /> ]WEEL# RE SSURE GROUT <br /> S3#trer Grout SpecaC�ra �,O7 _ <br /> :OMMENTS <br /> . I <br /> ] E OF WELL INSTALLAmON TYPE CON57RUCTION SPF-CiF=TWNS <br /> I MONITORING 17 HOLI-OW STEM DW.OF 50REHCLS 2" MULTIPLE CASINGS?j1 MULTI-4-VEL)g WELL CASING OIA; <br /> 1 EXTRACTION 11 AIR I-tAMMEEMIR1VEN CASING THIGKNESS Yj4: ..—TYPE CF CASING. j[STEL a PVC jj G THM N/6 <br /> 1 VAPOR 1]MUD ROTARY PE,--r1 OF GRcuT SEAL S-3 ' TItiEMtE TYKE'I`D BE USED I7 AUC ERS OSE <br /> AMSPARGE T f OZCne)<PUSH POINT GRCU5 AL PUMPS] Q Yes -Z�Alo (NOTE' MAX11RUM FREE-FALL bEPTH I 3C') <br /> BORING ©HAND AUGER GROUT SPEGIFRCATIIONS.-PocrAmnFn!-_ <br /> [OTHER tl OTHER APPROX BOiZiNG OtBa"fFi �9 f jl B4L7Bi1 TRAFFIC BOX or U STOVE PIPE <br /> s' G7NDUCTOR CASING PRCPOZI ('t'1=,Ilst specfflcatfonS here)_ <br /> GaM1llt175' <br /> T NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMIT'S. <br /> CALL THE UNrr IV INSPECTOR 48 WOFMNG HOURS 1N ADVANCE FO ALL RJ=QUIP INSPECTIONS. <br /> hereby cerbty that 1 hatre prepared WS 2pplica1U0n and that the work will be done in m=ordanae with Stn Joaquin <br /> :aunty Olydiparl+r..es, Rules and latrans,and Ali applicable California St2tn Laws. <br /> agned x TltieCarr>party0 <br /> 'rtnt Rimm a t]ate_,, 1 - A 7 n Y <br /> DEPARTMENT USE ONLY <br /> WrE MAP IN unlrr lv FILE,AnDREss: '-- <br /> r <br /> YORK PLAN DATED: 0 <br /> ,ppiicat:on A=pted Oat9 l� F pu sa � <br /> lrautlhspecOm By Date ---- Firmj Inspomn Bye Date <br /> lshurlion Ihspecdon By Date . <br /> N'rS f CONOfiiOAFS. - <br /> ACCOUNTING C*&Y` AW - - <br /> ES FrZE JIV-0 AMOUNT REMRTED CHECKS FWC10 Flyf =SMtV=3lREQU95T# IM=X1 = 4A <br /> f pv <br /> jI <br /> 5' <br /> 57 WC___-WAr& C-57 Letter of Authorization to sign perm) Encroachment doc,.V 81ni <br /> F <br /> 3 <br />