SR0078835 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREA-rMENT SYSTEM PERMIT 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 EXPIRE/Sf11 YEAR FROM DATE ISSUED JOB ADDRESS '99, ! 5 fe 11�1�' "fp _.007-3S-0-08 �yr�_CITY/cZIP CROSS STREET - �141LS�_PCv47`� APN w J - 3S/ 0 y O S _ PARCEL SIZE OWNER NAME N �^'GS L VUs It _ _ _ PHONE OWNER ADDRESS �- 7 5 ` t I -er CITY/STATE/ZIP CONTRACTOR CONTRACTOR ADDRESS LICENSE ❑k-42 ❑' C-36 OTHER M PHONE X1 ,-Az f- 5060-17 CITY/STATE/ZIP f.O�� t� • NUMBER #S*q6, EXPIRATION DATE WATER TABLE DEPTH: & ft GEOGRAPHICAL INFORMATION ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: a NEW INSTALLATION A REPAIR/AD Coordinates X Y LAND USE APPLICATION # IN ENGINEER DESII NED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION INSTALLATION WILL SERVE: X RESIDENCE L1 COMMERCIAL 2 11 OTHER NUMBER OF LIVING UNITS: ( NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: JN LEACH LINES 1 1 LEACHING CHAMBERS # OF LINES LENGTH OF LINES 25.S, ft ` /00' o�'- ❑ SEPTIC TANK TYPE/MFG . j.�'1 CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST WELL ft DISTANCE TO NEAREST: WELL !OG ft FOUNDATION �S ft r PROPERTY LINE lU 1 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) JN LEACH LINES 1 1 LEACHING CHAMBERS # OF LINES LENGTH OF LINES 25.S, ft ` /00' / DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE® It ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It 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 SEEPAGE PITS NUMBER / WIDTH 7� ft DEPTH 495" ft DISTANCE TO NEAREST WELL f;5 ft t' FOUNDATION �S , ft PROPERTY LINE TS 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. 24 HOUR ADVANCE NOTICE REOUIRED FOR INSPECTIONS - SIGNED �'�*�� TITLE . ��i� DATE Ye.I , el - r�vtr Application Accepted By Final Inspection By Character of Soil to Dept of 3 t:. COMMENTS r+ e . i I , -. DEPARTMF_NTUSE ONLY Date Y— Area �l l Employee ID# �-t c Date ❑ SPECIAL PERMIT - Approved by �l Pit/Sump Soil Character: Pin IC -- PE Code SCReceived INFO Chec sh Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# —16 i s 3 a r3 )01 WS 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 #A - Con .j a 0 v z CA