SR0078282 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT fif --4%;, SAWJOAQUIN COUNTY ENVIRONMENTAL HEALI H DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT , / CALL 209 953-76 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS /� -Sj tf �� 5 L. CITy/ZIP CROSS STREET C� GV� _ _ APN I�" Q ! 0 ' 05PPARCEL SIZE !/' OWNER NAME V�7E-i : iD �Lj� /I �• L� ------ PHHON T27 ��j�+ OWNER ADDRESS +1� 2,1 CITY/STATE/ZIP T' /� C Q �+�� n PHONE CONTRACTOR CONTRACTOR ADDRESS ol CITY/STATE/ZIP LICENSE ❑ C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE_ WATER TABLE DEPTH: l ft GEOGRAPHICAL INFORMATION: CoOrdl ates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: R NEW INSTALLATION REPAIR/ADDITION v ENGINEER DE I( REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION'S INSTALLATION WILL SERVE: ❑ RESIDENCE 4ff COMMERCIAL 0W S NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: OTHER NUMBER OF EMPLOYEES: 0 SEPTIC TANK TYPE/MFG CAPACITY �Z�'J gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY _ gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL �V ft FOUNDATION ' ' ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) DISTANCE TO NEAREST WELL ft FOUNDATION I ft PROPERTY LINE Jln�. 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. ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL SIGNED /�� 1//1� TITLE DATE Application Accepted Final Inspection By �j{��j-��/yI, Character of Soil to Depth of 3 Ft: Area Employee ID#� ❑ SPECIAL PERMIT - Approved by r`hsrsrfnr- PE SC Received Check#/ Amount Date ,� Invoice # d LEACH LINES 1-1 LEACHING CHAMBERS INFO # OF LINES Cash LENGTH OF LINES ft e i e e uest # V U ft DISTANCE TO NEAREST WELL ft FOUNDATION J ft PROPERTY LINE ❑ FILTER -BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft 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 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Pl CFFPAr;F PITG NiiwRFR Z WinTH • ft DEPTH .Z J It DISTANCE TO NEAREST WELL ft FOUNDATION I ft PROPERTY LINE Jln�. 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. ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL SIGNED /�� 1//1� TITLE DATE Application Accepted Final Inspection By �j{��j-��/yI, Character of Soil to Depth of 3 Ft: Area Employee ID#� ❑ SPECIAL PERMIT - Approved by r`hsrsrfnr- PE SC Received Check#/ Amount Date Permit/ Invoice # Permit ID# Code INFO B Cash Remitted e i e e uest # 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17