Laserfiche WebLink
... SAN JOAQUIN COUNTY � <br /> ������ ENVIRONMENTAL HEALTH DEPARTMENT SITE <br /> 600 East Main Street, Stockton, CA 95202-3029 MITIGATION <br /> Telephone:(209)468-3449 Fax:(209)468-3433 Web:www.sigov.org/ehd UNIT IV <br /> FEB 11 20091 <br /> SERVICE T WELL PERMIT APPLICATION <br /> ENVIRONMENT HEAI„T _REFUNDAeLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> PERMIT <br /> Application is hereby madeeto San Joaquin County for a permit to construct and/or install the work described- This application is made in compliance with San <br /> Joaquin County Devebp7*nt Title,chapt 9-1115.3 and the Standards of San Joaquin County Envkonmerdal Health DeparMierd. <br /> NE e44yY N 4�t✓tAlb-- Assessors <br /> Well Location sidewalk,Rosemarie Ln.Cross Sheet North Pershing Ave. City Stockton Zip 95204 parcel# Public ROW <br /> Property209-937-8349 <br /> Owner City of Stockton Address 425 N, R1 Dorado Street City Stockton zip 95202 Phone# <br /> C57-717530 g16-638-1169 <br /> C57ContractorCascade Drillino, Inc Address 3632 Osec Circle City Rancho Cordova Lic# Phone <br /> ConsultanUSub Cntr RYIC 8aginsering Address 2285 Morello Ave. City Pleasant Hill Lic# 624022 Phone 925-602-4710 <br /> GIS Coordinates:X ,Y ,Township 02N Range 06E Section 28 <br /> WORK TO BE PERFORMED: <br /> ®NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER-) ❑DESTRUCTION(CHOOSE TYPE BELOW) <br /> [I SOIL BORING* ❑OVER-BORE DIAMETER <br /> ®WELL NW14 ❑PRESSURE GROUT <br /> ❑'OTHER GROUT SPECIFICATIONS <br /> COMMENTS: L' P <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ®MONITORING [SHOLLOW STEM DIA.OF BOREHOLE 8* 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: 2. R <br /> ❑EXTRACTION ❑AIR HAMMER/DRIVEN CASING THICKNESS Sch- 40 TYPE OF CASING:0 STEEL {]PVC ❑ OTHER O <br /> between <br /> ❑VAPOR ❑MUD ROTARY DEPTH OF GROUT SEAL 51'-58TREMtE TYPE TO BE USED$AUGERS❑HOSE <br /> ❑AIR SPARGDOZONE ❑PUSH POINT(GP OR CPT)_GROUT SEAL PUMPED:❑Yes Eff No (NOTE:MAXIMUM FREE-FALL DEPTH IS 30') -4- <br /> ❑SOIL BORING ❑HAND AUGER GROUT SPECIFICATIONS Neat cement <br /> ❑OTHER: ❑ <br /> OTHER: APPROX.BORING DEPTH between 70'-80'®BOLTED TRAFFIC BOX OR []STOVEPIPE 1 <br /> Q7NDIICTOR CASING PROPOSED Yee (ilYEs,W specific som in mmment s m) <br /> COMMENTS: 8-5/8. O D steel conductor casino from surface to -55' <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS <br /> I hereby certify that I h pared this application and that the work will be donne 1 accordance with San Joaquin County Ordinances,Rules and <br /> Regulations,a 41513l California Laws. ` /,1 <br /> Signed / T.Comtp .,/C G\16AA_C- 'D Vl I 1 i n�1 I I !�(� <br /> Pdnt Name , FEf�Iy ` o-raM t Il o l 6{.S NC t-. ) Data 2-15 <br /> DEPARTMENT USE ONLY <br /> J��['/ <br /> SITE MAP IN UNIT IV FILE,ADDRESS: L 7 T plASA-b 5 <br /> WORK PLAN DATED: WL �/l� � p <br /> APPLICATION ACCEPTED BYYlF/1 n� DATE ISSUED •Z. /t AREA" <br /> GROUT INSPECTION BY 416- rQ _ FINAL INSPECT10*44101 DATE <br /> DESTRUCTION INSPECTION BY DATE <br /> // ff DATE t� A / [ •,r�[[[ <br /> COMMENTS/CONDITIONS: I_Iltt li"102 /LI,w /�1 C�CDC6-1.., SS 7-39 [ Z �C, a y��� -115 . <br /> ACCOUNTING ONLY: AID# FAC# 4 <br /> PECODES FEE INFO AMTREMITTED CHECK# RECV'D BY DATE PERMITRERVICE# INVOICE <br /> 350 8,1 - ge,- 04/11 &'4 It D9 I SR#DaSGSO(o <br /> C-57 WC -WAIVER C57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC <br /> EHD2 01 II1W7(WEB) WELL PERMIT APP <br />