Laserfiche WebLink
,, _ .d FILE COPY <br /> San Joaquin �u'�ty <br /> ��; <br /> i Environmental Health Departme 0 Eca C/« , SITE <br /> w 304 East Weber Avenue,3rd Floor, Stockton,CA 95202 ITIGATION <br /> (209)468-3449 Fax: (209)468-3433 Web: www.sjgov.org"d - j P007 UNIT IV <br /> /Fo " Well Permit Application ENVIRONMENT HEALTH <br /> NON-REFUNDABLE PERMIT EXPIRES t YEAR FROM DATE ISsP&OMIT/SERVICES <br /> Application is hereby made to 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 Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> Assessoy 16ovo <br /> WELL Location 14749 Thornton Road •pCrross/s StreetCapitol Ave City,Lodi Zip 95242 Parcel# �J <br /> PROPERTY t �a& � nr <br /> .� - ' -- I 96 `� CA C 3381y <br /> Owne Address City Zip Phone# 914 <br /> Cascade Drilling, Inc Sacramento <br /> C-57 Contractor Address3632 Omec Circle CityZip95742 Lo#_W 5/OPhone# (916)638-1169 <br /> Consultant/Sub CntrA[ryGE Address837 Shaw Road CltyStockton Uc#680227 Phone# (209)467-1006 <br /> GISCoordinates:X 3D. Lig{ ,Y--I--1.395 ,Township Range Section <br /> WORK TO BE PERFORMED: <br /> )KNEW WELL/BORING (CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER-) a DESTRUCTION (choose type below) <br /> a SOIL BORING# a OVER-BORE. DIAMETER <br /> )KWELL#VW-9 VW-S VW-(o w' fuv6Jk AW-l$ aPRESSURE GROUT <br /> a*Other r GROUT SPECIFICATIONS <br /> COMMENTS: SE£ �H (J APPAOvcD In19JK nl dwreo f) j�3T <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS I �� <br /> a MONITORING -IOLLOW STEM DIA.OF BOREHOLES' a MULTIPLE CASINGS a MULTI-LEVEL WELL CASING DIA:-K <br /> a EXTRACTION /a `AIR HAMMER/DRIVEN CASING THICKNESS Sw _1 Z TYPE OF CASING: a STEEL,--b\PVC a OTHER: <br /> VAPOR a MUD ROTARY DEPTH OF GROUT SEAL IS TREMIE TYPE TO BE USED: AUGERS a HOSE <br /> 11 AIR SPARGE/OZONE a PUSH POINT(GP or CPT)GROUT SEAL PUMPED: a Yes_11�o (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> a SOIL BORING a HAND AUGER GROUT SPECIFICATIONS Por r)A v 1 V MAXIMUM <br /> a OTHER: 0 OTHER APPROX.BORING DEPTH 25 g90LTED TRAFFIC BOX or a STOVE PIPE <br /> S D A OT-�1NDCTI1OR CA/SING PROPOSED - (if YES,list specifications in comment section) <br /> COMMENTS: � C,)1 Y(we (I IT�0 09 Z/cp:� <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 OrdinanW, 131u1�and egulations, and all applicable California State Laws. <br /> Signed x and <br /> Title/Company Vice President/AGE <br /> Pdnt Name Robert E. Marty Dale21 September 2007 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE, ADDRESS: 4� / 7%aei� <br /> WORK PLAN DATED: 31 O <br /> Application Accepted By 4 Date Issued <br /> l Z Area !O <br /> Grout Inspection By ZDate 11- [7,0 1 Final Inspection`jl. m .z <- Date <br /> Destruction Inspection By Date <br /> COMMENTS/CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK# REC'D BY DATE PERMIT/SERVICE REQUEST# INVOICE <br /> o "38`3 • 2(pp3 I y <br /> IC)- I S R# Z/ 3 <br /> C-57_ WC=WAIVER_ C-57 Letter of Authorization to sign permit_Encroachment doc_ <br /> EHD 29-02-001 <br /> 6/22/04 <br />