Laserfiche WebLink
JUL-23-2007 16:30 FROM:MWH GLLP­ 916 418 8522 TO: 464 6059 P.2 <br /> p San Joaquin County <br /> : Environmental Health Department SITE <br /> m < 304 East Weber Avenue,3rd Floor,Stockton, CA 95202 1171GATION <br /> (209)468.3449 Fax: (209)468.3433 Web; www.sjgov.org/ehd UNIT IV <br /> c �a' Well Permit Application <br /> NON-REFUNOABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application is hereby made to San Joaquin County for a perrml W construct aodlor install the work described This application is made in compliance with San <br /> Joaquin County Development Tdk,Cisap4er 9.1115.3 and the Standards of San Joaquin County Environmental Heellh Department. <br /> Assessors <br /> WELL Location /,So A!. Sa ecla rs BI/E. Cross Street J"Y9771.E City S7711 Zip SZeS Parcel# 7590x070 <br /> PROPERTY <br /> Owner MA, [Iix .._ Ps Addrocs 211 .V sT ,r City sKr wa..AVZiplath Phone# -ZL{1. <br /> C.57 Contractor RSC Address%Zo Al.BAIT' M City] e" Iwd ZWf577L LicaIIIIIsR3�Phones-t'3n-cit- <br /> Consultant/Sub CnirMh7 w.sr. b �� <br /> eal _ Addrecb 3J2I Fi196 ]tare say lidr�Phpnep_ 4ff -1!S$ <br /> GIs Coordinales.X(PP""11 •4 Y 817677 r,1S 7 ,Township Range Section <br /> wORK TO Be PERFORMED: <br /> TIEW WELL 1 BORING LPT EOPROS ,HYOROPUNCH,HAND-AUGER,OTHER•) %DESTRUCTION (Wloose type tutiow) <br /> SOIL BORING# S Q OVER-BORE- DIAMETER <br /> Q WELL R A,RESSURE GROUT <br /> D'Other GROUT SPECIFICATIONS <br /> COMMENTS: _- <br /> TYPEOF WELL IuIsPktK)MON TYPE CONSTE!UCTION SPECIFICATIONS <br /> ti MONITORING Q HOLLOW STEM OIA OF BOREHOLE" Q MULTIPLE CASINGS D MULTI-LEVEL WELL CASING OIA: A/ar <br /> Q EXTRACTION D AIR HAMMER/DRIVEN CASING THICKNESS a-4 jYPE OF CASING: Q STEEL Q PVC U7HER: 041A.4 <br /> D VAPOR Q MUD ROTARY DEPTH OF GROUT SEAL 0�rr TREMIE TYPE TO BE USED:X Q HOSE <br /> DAIR SPARC E/OZONE ;CUSH POINT(CP or CPT)GROUT SEAL PUMPED: D Yes Q No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> /VOIL BORING Q HAND AUGER GROUT SPECIFICATIONSCm.r.7i' <br /> 0 OTHER: D OTHER APPROX.BORING DEPTH SSS D BOLTED TRAFFIC BOK or 0 STOVE PIPE <br /> CONDUCTOR y C�A�S/ING PROPOSED NIti4 (if YES,list specirrcations in comment seulon) <br /> COMMENTS: Swe L kmr/wsi I II k w3aal. 4v """7"~"� ,d ly*W J,m„d 01.4 5-rc Uao 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 Ordinances,Rules and Regulations,and all applicable California State Laws, <br /> Signed x � !/ a r. ,_ TitlWCompany 0!2 ib 7wq 4 "a.II <br /> Print Name /t'lIKl%C.,Cd" Date <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: <br /> WORT(PLAN DATED: <br /> r <br /> Application Accepted By Date issued I Aro <br /> Grout inspection By Dale l0 Final Inspection By Data 6- b <br /> Destruction!nsp®ction By Dale <br /> COMMENTS/CONDITIONS: <br /> ACCOUNT114G ONLY'. AID# FAC-1 <br /> PE CODES FEEINFO AMOUNTREMITTED CHECK# RECD BY DATE PERMIT/SERVICE REQUEST Y INVOICE <br /> t �l 380 SR# �3 3 <br /> C-57, WC,_-WAIVER____ C-57 tetter of Authorization to Sign permit—Encroachment doc— <br /> FJID 29-01-00 1 <br /> v2zro-, <br />