SR0078730 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT fl SAN JOAQUIN COUNTY ENVIRONMENTAL 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 ADDRESSy ��i�'i lt�, r 14-0 CITY/ZIP j�-,5:-�yl Jit =- !7-> (:-'BOSS STREET APN a5 /00 i PARCEL SIZE OWNER NAME l / 1 PHONNE�j�(�'�/ bWNER ADDRESS l R �b7 �14 �+ � CITY/STATE/ZIP "'�- t/ f �r, " /s�Jli�f CONTRACTOR 5 A KK PHONE � �L CONTRACTOR ADDRESS L7 5!_lj CITY/STATE/ZIP i' ✓�✓I«.��- t Z-��' �� _3��. LICENSE ❑ C-42 ❑ C-36 OTHER •T NUMBER EXPIRATION DATE :fcid r WATER TABLE DEPTH? ft GEOGRAPHICAL INFORMATION: ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION R PAIR/ADE Coordinates X Y LAND USE APPLICATION # REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE Ll COMMERCIAL Ll OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: -3 NUMBER OF EMPLOYEES: ILS SEPTIC TANK ❑ GREASETRAP n TYPE/MFG$+ TYPE/MFG CAPACITY CAPACITY DISTANCE TO NEAREST: WELL tW ft FOUNDATION ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT LEACH LINES I LEACHING CHAMBERS DISTANCE TO NEAREST WELL t�) t ft FILTER BED WIDTH ft LENGTH DISTANCE TO NEAREST WELL MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL TERNATIVE — v gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) _ # OF LINES LENGTH OF LINES '3,-) ft FOUNDATION 1 0� ft PROPERTY LINE 1 0 1 ft ft DEPTH _ ft ft FOUNDATION Area Employee ID# ft PROPERTY LINE ft 1-1 SPECIAL PERMIT -Approved by ft DEPTH ft ft FOUNDATION Invoice # ft PROPERTY LINE ft 1 ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT 1 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. SIGNED Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS Date Date �J��I! AIJAL ��/IIY-1Lb1fC TITLE e "7J -N DATE ;L 1,3 15 JSE OAU Y Area Employee ID# Received B 1-1 SPECIAL PERMIT -Approved by Pit/Sump Soil Character: PE Code SC INFO Received B Check#/ Cashr Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 1 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12 U.