SR2400382 (2) - Laserfiche WebLink

Home Browse Search

SAN JUAWN Environmental Health Department —COUNTY— =i Greotness grows here. SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours Advance Notice Required For All Inspections (g 24 000?3) CALL (209) 953-7697 For INSPECTIONS 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 County Development Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. Job Address Southern corner of Searchlight Ave. and East Anderson 3tity/State/Zip Stockton, CA 95205 Phone cress street Searchlight Ave. and East Anderson St. APN NA Property owner* City of Stockton r t) S O v.) Phone 209-937-8366 Address 345 N. El Dorado St. city/state/zip Stockton, CA 95202 C-57 Contractor Cascade Drilling License# 1058336 Phone 916-638-1169 Address 3000 Duluth St, Clty/State/zip West Sacramento, CA 95691 Consultant/Sub-ContractorATC Group Services LLC dba Atlas Technical License# Phone 209-579-2221 Address 1117 Lone Palm Ave., Suite 201 B City/state/Zip Modesto, CA 95351 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits TYPE OFWELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 36 ft- ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporMater) ❑ HAMMERIDRIVEN DIA,OF BOREHOLE 31n_ ❑MULTIPLE CASINGS❑MULTI-LEVELWELL CASING DIA ❑ SOILVAPORPROSE ❑ MUD ROTARY CASING THICKNESS TYPEOF CASING: El STEEL ❑PVC ❑ OTHER ® SOIL BORING _�ED PUSH POINT(GP/CPT) CONDUCTORCASING ❑Yes ®No Woo Ole: Cazllg Dia: Casing Depth: ❑ INJECTION(Akeoaree.Ozane) ❑ HANDAUGER GROUT SEAL DEPTH TREMIE TYPETO BE USED: [I AUGERS ❑HOSE ®PIPE ❑ OTHER ❑ R ad OTHE : GROUT SEAL PUMPED? ❑Yes El (Note:Mmum Freefd Depth is 30 FQ WELUSOIL BORING IDs Ju r !�yn� GROUT SPECIFICATIONS nPAt rennP.nt DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of feet WELL Ds ❑PRESSUREGROUT Todepthof feelhelowsudace GROUT SPECIFICATIONS [I EXPLOSIVES From_to_feet below surface TREMIE TYPE TO BE USED [I AUGERS [I HOSE [I PIPE ❑ MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS: i I hereby certify that I am authorized to complete this application and that the work will be done in accordance with / SMan,¢J.oa.quin County Ordinance Codes and Standards, and all other applicable California laws. Signed )111 Title/Company Project Manager Print Name Matthew Tolbert Date 7/29/2024 DEPARTMENT USE 6Y'11 * Date Issued:Application Accepted By: IV.Vi'-� Grout Inspection By/Dates: � Destruction Inspection By/Dates: "166A - Facilil /Site Information FAName FAAddress V , eL rA FA# 0 2 PR# FA PE WP Reviewed By Work Plan Date 1 3 0C-57 C57Authodzatian for Other to Sign Pelmk ❑Workers Comp ❑Workers Comp Waiver ❑Encroachment Permil ❑AccessAgreemenl ad Agent oval MFR COMMENTS) ON ITIONS: / In�i.L /_/ �Q�d r-0< WP TYPE PE I SC I FEE INFO JAMT REMITTED `CHECK# RECV-D BY D TE WELL PERMIT# INVOICE# Permit 2yos 3 i3 $ I 1 -4 2 C C Jyj I 8' 4 Z9 W P Z g001:Z CG� �gb 2 �� 183 SR �}00382 1868 E. Hazelton Avenue I Stockton, Cal ornia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 7-01-2023 Ske Mitigation Well PermilApplioation