Laserfiche WebLink
12/0812605 16 24 2094683433 EHD PAGE 03 <br /> WELL PERMIT APPLICATION��I r'' `=j�1TE <br /> SAN JOAQUIN COUNTYIEITIGATION <br /> ENVIRONMENTAL HEALTH DEPARTMEN"DR <br /> 2005 UNIT IV <br /> 304 E_ Weber, Third Floor, Stockton, �P0 <br /> (209) 468-3449 &THULTy <br /> h[QN-REFUfADABLF PERMrr"PIKES 1 YEAR FROM C18Z IS�SUEv��IC�S <br /> ARPltcat1on is hereby made to San Joaquin County for a permat to construct andaror mtap the woi*described. This appilMbon is made In comptfarce wdh San <br /> Jaacl=COUn Y L&velopment True,ChapW-&11'15 3 and the Standards of San Joaquin County Enwonmental Health DepartrnerrL <br /> WELL Location L' �! Cross Smet City vQ ___,;:Ip ParcoW M/S <br /> PROPERTY y cr <br /> ©caner _�9 l t, Dov Address 1910 E _ y!� � C,cy zp 15 ! -7 <br /> Owner <br /> C-67Contra r r 110 Add ff �p_,B0 P- 33� city UI zip�ljc*7fa <br /> COnsuRtant I Sub Cntt l~t, 1 y s n,yt�� r C, ' d`area�6tm' r, ESr. `} y -7 Plwne ^J34�� <br /> GtS Coordinates X ,Y ,Township Range Section <br /> RK TO BE PgRFORMED- <br /> EW WELL(BORING (CPT.GEOPROGE.HYDROPUNCH,HANQ AUGER,OTHER`) DESTRUCTION (choose type below) <br /> j(SOIL BORING�}�W'~20 _ 11 OVER-BORE <br /> DWMETER <br /> 1]WELL -. _ (I PRESSURE GROUT <br /> j]*Outer GROUT <br /> SPECIFICATIONS <br /> COMMENTS <br /> TYP OP WELL tNSTALU4TION TYPE CON STRUa )_ON SPECiFIGATIONS <br /> )KNIONITORING " L"HoLLOW STEM DIA OF BOREHOLVjL rl MULTIPLE CASINGS j)MULTI-LEVEL WE-LL CASING:DUB <br /> 11 EXTRACTION [I AIR HAMMEPJDRIVEN CASING THICKNEB85L4.40 TYRE OF CASING I)STI=EL XPVG j]OTHER __ _ <br /> QR a MUD ROTARY DEPTH OF GROUT SEAL Cf J TREIVIE TYPE TO BE USED AUGERS 2 HOSE <br /> mW SPARGE]OZONE= Ll PUSH POINT(GP or CPT)GROUT SEAL PUMPED ) Yas p 1410 (NOTE, MAXIMUM FREE-FALL DEP IS 30') <br /> rl SOIL.BORING 11 HANG AUGER GROUT SPECt ICA'nONS_n$4 94*stj I�i�17'I �+f-_ <br /> a OTHEIR OTHER APPROX BORING DEPTH. LLLL _ Q BOLTED IR C SOX or 11 STOVE PIPE <br /> CONDUCTOR GASSING PROPOSED Ab (if VMS,I*t specifications in comment Section) <br /> COMMENTS <br /> [MOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORYJNG HOURS NOTICE REQUIRED FOR INSPECTIONS <br /> I hereby certify that I have prepared this application and that the work will be done in accordance Wath Sass Joaquin <br /> County Ordinances, Rules and egulat ons, and all applicable California State LaWS. <br /> Signed x ._ Title/Company Aa,_ &LAg J�_r�. TOCK .. <br /> Prfnt Name G W C" deL Date_ <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE, ADDRESS: ��7�� S- Th,-4e "SOn 'Pa x.r <br /> WORK PLAN DATED: r h <br /> �ppiacation ACCepted Fay w !V VG f !.w �Eri 1W S% —Date;- ,"Date issued [a ayC h t O S Arca^ '_57. ^ <br /> 3rout Inspechon 8y Oate Finaf Inspect(on By T <br /> Date <br /> )estruction Inspection fay nate <br /> OMMENTS f CONDITIONS. <br /> Ac NG ONLY AJD# FAC# S 0611 513$ <br /> ZEES PEE IAdI(a AMOUNT F'�MITTEI? CHECK RECD BY QATE PERMIT!S�I�VICi=REQt1E5T INVOICE <br />