Laserfiche WebLink
J Fib-t� 1 vit ay'- Grcgg Drilling & Testing Inc. ; 92!:, :jI3 U3U1; I : �t,, r��y� " <br /> may. <br /> 07/12/2001 14:29 2094678 AGE STOCKTON PAC:: 02 <br /> WELL PERMIT APPLICATION FORPI/ <br /> S � <br /> dr <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES- MI TION <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) UNIT IV <br /> 304 E. Weber, Third Floor, Stockton, CA.,'95202 <br /> (209)4683449 <br /> NON-REFUNDAULEPgAmrr IIXPIRER 1 VEaR Mom DATE 1mi&ij <br /> Appi"tiorn Is hereby nlaide to San Joaquin County for,2 ppmltt to cLvlsuucl pnc/a Instal the ypr�d"cai4ed compliance with aDpilcatiDn is mads In complianwith Sen <br /> Josaquui County.Development TIUe,Chapter 9-1115.3 end the Slarxaras of Sun Jorrquih County RUNIC HavA h Serviws, Envi(Ofwm,ltal Hein h Division. <br /> ALL Loudon <br /> Cross ross Sree _ � CJry2� E ZIP q 510 L <br /> PROPERTY �0' Asoseals�►s <br /> ora <br /> l� Zip !Phhoonell \ <br /> C-57 Contractor <br /> ConiuIrtard/Sub Contractor g dress D3� p1� _C,RyS� l�„�,oy 66Ozprwr,0_�t L:1—I n n/ <br /> GIS Coadlnstes•X —Y Township Rang• S.CUon +�� <br /> M <br /> EVtf WELL UUQRHJO C GEOPR09E,HYDROPUNCH,HAND-AUGER,OTHM) a DESTRUCTION(choose type below) <br /> p SOIL BORING a 0 OVER-WR1E <br /> 11 WELL N a PREBSUft GROUT <br /> 'QeMr. Oroul 9podficattaris: <br /> COMMIENTS: <br /> DTF OF WELL x21ALI619N TYpE OONSTRUCTlQN 9��dCIFPCAT14N5 <br /> 0 MONITORING D HOLL.Ow STEM DIA.OF 50REHOLF2— MULTIPLE GASINGV Q YIE3 ONO WELL CASING DLA.- <br /> [I EXTRAC 101"I 0 AIR HAMMER/DRIVEN CASING THICKNESS _TYPE OF CASING: DST-EEL O PVC 0 OTHER: <br /> D VAPOR Q MUD ROTARY OEPTH OF GROUT SEAL .O r TREM1E TYPE TO BE USED: jlgAUGERS D HOSE <br /> 0 AIR SPARGE '&BUSH POINT GROUT SEAL PUMPED; UYes Q No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> D SOIL BORING <br /> r U HAND AUGER GROUT SPECIFICATKWS: PchAl a ,��� •Lw <br /> it R_- <br /> HE _C t Jl OTHER APPROX.BORING a1=PTH r D BOLTED TRAFFIC IIOX or 0 STOVE PIPE <br /> F NDUCTOR CASING PROP03eC? 9Q (It YES,list spedficahons hero): <br /> 'COUMrENTS:_ <br /> 1T tilitQ <br /> NO : rOFFSIT 90§IN4S RI_(QUIRE ACCESS OR ENCROACHMENT PERMITS. <br /> CALL THE UNIT- IV INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS_ <br /> I hereby eertf}y that I have prepared thl3 appllcation and that the work will be done In accordance with San Joaquin <br /> County Ordl rices, Is and Regulations, and all applicable California State Lowts, <br /> Signed Tit /Gcmporty 15 Uaa4°A' Xp St1 i-QtnLt u, <br /> Print Nam. N Lee- pate udru r_ Q <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT W FILE, ADDRESS: <br /> WORK PLAN DATED: <br /> Applicatlon Accepted By d Dote Issued 13 0 1 A. <br /> Grout Inspection By F-iPaI In44dion By Data <br /> Deatructlon Inspeotivn By Date <br /> COMMENTS/GONOrrIO11S: <br /> ACCOUNTING ONLY; AIDI; <br /> PE CODES FEE W F 0 AMOUNT RE CHe KV lRCC'D BY DATE PERMIT 3EAVICE REQUEST Wva10E <br /> L5 P-S <br /> C-57 WC=WA1VCR__ C-57 Letter of Authorization to sign perMit_Encroachment doc— 9/27/00 <br />