SR0078718 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P �r SAN JOAQUIN COUNTY ENVIR014MENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT - CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS CROSS STREET 7 CITYY/r/ZIP_ APN " 645_17 PARCEL SIZE O 1 y OWNER NAME CfJ (j/V�( OG -1 / p Lej**!!�1 if JF` PHONE OWNER ADDRESS �CITY/STATE/ZIP CONTRACTOR 14.0 ��C 0-e, PHONE LI-00— CONTRACTOR I-00—CONTRACTOR ADDRESS CITY/STATE/ZIP 0l C•7j_+ +' Gv4- 47-5-33A LICENSE ❑ C-42 ❑ C-36 OTHER—A& NUMBER _ _ EXPIRATION DATE caw % WATER TABLE DEPTH: u ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # _ LAND USE APPLICATION # TYPE OF WORK: 1 NEW INSTALLATION REPAIR/ADDITION i ENGINEER DESIGNED/ALTERNATIVE C!' SEPTIC TANK TYPE/MFG P411 CAPACITY _4Z51M gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL �a It FOUNDATION I ft PROPERTY LINE dOt ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH -ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN _ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE_ etL &d (` DATE CCA K/ IV(C IY J r V 94 L r Application Accepted By Date .1 �_ Area _L — Final Inspection By _.__�_ Date Z X LI SPE Character of Soil to Depth of 3 Ft: it/Sump Soil Character: I COMMENTS _771 i I _�( Employee ID# L PERMIT - Approved by I PE Coe SC INF Received By Check#/ Cas Amount Date em' d Permit/ Service Request # Invoice # Permit ID# 1 �3 0 ori Si8 42-01 5/5/17 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT