My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SR0078295
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
T
>
12 (STATE ROUTE 12)
>
11124
>
4200/4300 - Liquid Waste/Water Well Permits
>
SR0078295
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/19/2024 3:48:03 PM
Creation date
3/5/2018 9:56:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078295
PE
4211
FACILITY_NAME
JOSEPH REIFF
STREET_NUMBER
11124
Direction
E
STREET_NAME
STATE ROUTE 12
City
LOCKEFORD
Zip
95237
APN
05114055
ENTERED_DATE
3/5/2018
SITE_LOCATION
11124 E HWY 12
RECEIVED_DATE
10/23/2017
P_LOCATION
99
P_DISTRICT
004
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
3
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
' ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS LXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS il+1121' 4AIq CrrY/zIIP ` 1 <br />CROSS STREET `-ry -e-VAeA4j ry APN Oro " ! (� ' �✓ PARCEL SIZE `- <br />OWNER NAME I I-fes''dei - I J U`S F�1 �C PHONE i <br />OWNER ADDRESS ' S N wy CITY/STATE/ZIP LO t: KP -f &r <br />CONTRACTOR (� (,I w I/CN , C- PHONE `? ��IL T 57099�y <br />OI9 7` <br />CONTRACTOR ADDRESS �3i O sdN _ CITY/STATE/ZIP ap//�i C iJ <br />LICENSE CIRC -42 l I C-36 OTHER NUMBER J�f�._EXPIRATION DATE, 9�aI 9 <br />WATER TABLE DEPTH: <br />I ft GEOGRAPHICAL INFORMATION: Coordinates X _ Y <br />Received <br />By <br />❑ <br />PERC TEST # <br />BUILDING PERMIT # PA <br />- l-4 of) X54 LAND USE APPLICATION # <br />Invoice # <br />TYPE OF WORK: <br />NEW INSTALLATION I 1 REPAIR/ADDITION LI ENGINEER DESIGNED/ALTERNATIVE <br />�/ <br />REPLACEMENT 11 OUT -OF -SERVICE SEPTIC SYSTEM F1 DESTRUCTION <br />1t, <br />INSTALLATION WILL SERVE: ,K RESIDENCE ❑ <br />COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />�,( <br />laL <br />SEPTIC TANK <br />TYPE/MFG �_ <br />CAPACITY �Q00 gal # OF COMPARTMENTS_ 2 <br />/❑_ <br />GREASE TRAP <br />TYPE/MFG _ <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL SEI ` ft FOUNDATION /O / ft PROPERTY LINE 3 ` <br />ft <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES_ LENGTH OF LINES 80 <br />ft <br />�� <br />/S 30 I <br />DISTANCE TO NEAREST WELL [ ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />SEEPAGE PITS <br />�J <br />NUMBER 3 WIDTH %�.ii <br />' <br />�� ft DEPTH <br />It <br />DISTANCE TO NEAREST WELL /� ft <br />FOUNDATION Jr� ! _ ft PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED _ __ TITLE___ DATE /0 - <br />DEPARTMENT USE ONLY <br />Application Accepted By P Date ID — 2- -I Area 9 hl_ Employee ID# <br />Final Inspection By k0 Z 1 ate ZLqZ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft:Pit/Sump Soil Character: <br />COMMENTS <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />il�ll <br />�/ <br />51 <br />1t, <br />23 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />T <br />
The URL can be used to link to this page
Your browser does not support the video tag.