SR0044738 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3NO FL-STOCKTON CA 95202 - (209)468-3410 NON-REFUNDABLE PERMIT Cy}A/LL 209 99533-7697 FOR INSPECTIONS EXPIRES_I YEAR FROM DATE ISSUED JOB ADDRESS � ,1�✓ 'v� nyV 1 CITYIZIP CROSS STREET APNN/y• .1 f 3 "' ��,��'�q/3 j PARCELL S`"ZE. d OWNER NAME =,-7� t �. -• PHONE �C� OWNER ADDRESS .rJ l� G'y(l e CITY/STATEIZIP;�74C�tL�C'7�l IB+J� �j I` CONTRA CTOR1 ' f f� PHONE i CONTRACTOR ADDRESS CITVISTATE/ZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATERTABLEDEPTH: ft GEOGRAPHICALINFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADD ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENTD TRI;ICT ra y q. !i y INSTALLATION WILL SERVE: RESIDENCE ElCOMME --- (�A _ I t �9 ' 11 a NUMBEROF L[V[NG UNITS: NUMBER OF BEDROOMS: 3 - NUMBER OF EMPLOYEES: s. pej m!t may nge ,,,• IL11 SEPTIC TANK TYPE/MFG CAPACITY spe -ted t, gal OF 4�PfOMP{ TMENTS ❑ GREASE TRAP 'TYPE/MFG CAPACITY 11 1�t ngalcOUR AAARRTaMEN« ElPKG TX PLANT DISTANCE TO NEAREST: WELL $ FOUNDATION b.I._+.� 'ff' PRdt1RfiYlF �ll�l� O�I1 — ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINEs LENGTH OF LINES ft DISTANCE TO NEAREST ! WELL ft FOUNDATION ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft N DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft V1 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft -n. DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 'I} ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MIN M M OUR ADV CE NOTICE REQUIRED FOR INSPECTIONS-PLEA :C 1,(209)953-7697 II SIGNED TITLE DATE l EV Nb "'Fw�;,K%TMENr t i Ik I -- - :.ti,..�, .�..r-:•ya.s-.: ,r^ or:T� � rT" ✓ a;`_r ?�'r'e.s wr �- }r •""` � � �.T x �-_- �.ic= ,--�, ,4 DEPARTMENT UST ONLY_ Application Accepterof 41 Date O� Area Employee ID# Final Inspection By _ Date d ❑ SPECIAL PERMIT-Approved by Character of Soil to PitlSump Soil Character: '. COMMENTS S-E-u1p Gc7 .1•�Ec.r—zoo n�c� Q Z. ` PE SC Received ount Date Permit) Invoice# Permit ID# Code INFO B ;j]jRemitted Service Re uest# -- 42-02-001 �' ONSITE WASTEWATER PERMIT 12/22/2003 - r