Laserfiche WebLink
['DESTRUCTION (choose type below) <br />a OVER-BORE. DIAMETER <br />PRESSURE GROUT <br />SPECIFICATIONS <br />/GC <br />Date Issued 5- -.24 —.0 Area obryi <br />Date Final Inspection By <br />E.%ate <br />c-Ar <br />Date <br />mv1/4/ <br />PE CODES FEE INFO AMOUNT REMITTED CHECK # EC'D BY DAT <br />5-5D I <br />C-57 %/ WC -WAIVER C-57 Letter of Authorization to sign <br />INVOICE <br /> pao-, Do <br />mit v Encroachmentdo . -4 9/30/02 <br />Application Accepted By <br />Grout Inspection By <br />Destruction Inspection Di <br />COMMENTS / CONDITIONS: <br />[ ACCOUNTING ONLY: LAID# <br />Title/Company <br />41- Date 57 <br />Ordinance ules <br />Signed x <br />Print Name Ea4 <br />gulatio , and all applicable California State Laws. <br />dcz,kr--2z.Ze <br />/7 43 <br />SITE MITIGATION UNIT IV ORIGINAtta, <br />re Mvj /05 tat WELL PERMIT APPLICATION FORM <br />tirg° SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT (EHD) Cr <br />/ <br />//61e (209) 468-3449 <br />304 E. Weber, Third Floor, Stockton, CA., 95202 <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <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 Joaquin <br />County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />Zip Phone# <br />C-57 Contractor '17c--.'_C-1-__L)1,1../ Address 2 -6,,,.;-,tki)c_.--m4fszt City 5.K— pc/6Lic#672-214hone# <br />Consultant/Sub Cntr 1=7:r ( -Ii( LL arilibEigss 17:71. i9A-)iLi CizK Litilf tOp t Lic#01'7'52- Phone# <br />0 <br />GIS Coordinates: X <br /> <br /> , Township Range <br /> <br />Section <br /> <br />Assessors <br />WELL Location Z.Z1 Cross Street,004(4City 5/Zrkroki Zip676-Zr>5— Parcel# <br />PROPERTY OwneLI2/L1 ELL_ 1, ref? TY-L. Address /la( Pr— City <br />WORK TO BE PERFORMED: <br />COMMENTS: 1.1) IC jQ 1 IAN T7-{ 2 -1( (--"Ar.;/ /405 60' aa".-7/ <br />NEW WELL I BORING (_c_PT, GE ROBE_HYDROPUNCH, HAND-AUGER, OTHER") <br />1120IL BORING # 1...i.) /6112 <br />DWELL # 4_4, <br />a •Oth <br /> <br /> I c.,,,-- .,/c, 0 3 kw-114 - lt"16` <br />145-15o' <br />TYPE OF WELL <br />KONITORING <br />a EXTRACTION <br />O VAPOR <br />0 AIR SPARGE/ <br />SOIL BORING <br />D OTHER: <br />COMMENTS:N 15 V 0 F-3( -d-k <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AG EEMENT OR ENCROACHMENT PERMITS. <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br />INSJALLATION TYPE CONSTRUCTION SPECIFIRpoNs <br />H'HOLLOW STEM DIA. OF BOREHOLE F-?((4 114-151ULTIPLE CASINGS a MULTI-LEVEL 1.11/U,L CASING DIA: <br />a AIR HAMMER/DRIVEN CASING THICKNESS cl II 1-0 TYPE OF CASING: a STEEL &PVC 0 OTHER: <br />MUD ROTARY DEPTH OF GROUT SEAL s'i-C% 4 S TREMIE TYPE TO BE USED: 0 AUGERS (1-11C1S-E <br />OZONE 0 PUSH POINT (GP or CPT)GROUT SEAL PUMPED: 0 Yes 0 No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br />g HAND AUGER GROUT SPECIFICATIONS C' C k <br />liK;ATED TRAFFIC BOX or ['STOVE PIPE a OTHER APPROX. BORING DEPTH tir' <br />CONDUCTOR CASING PROPOSED kVA- (if YES, list specifications in comment section) <br />CA <br />Joaquin Count't I hereby certify that I have prepared this application and that the work will be done in accordance with San <br />DEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS:c9-g-i/ Al.aid-41974- a41 <br />WORK PLAN DATED: lif'd <br />fr)