SR0078731 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER t'RCATN1ENT SYSTEM PERMIT Ple SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDAB PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED '^` r JOB ADDRESS �'�_�.'rA� � �s � _ - CITY/ZIP ' 1• �. � m A CROSS STREET i 1 �n� P __ APN _ t1'O PARCEL SIZE zb o ,OWNER NAME .1 '- C►YI SL"Q��ij--��j� '-ti��+Yj�-/ [�1 - - — PHONE OWNER ADDRESSCITY/STATE/ZIP ��,G2 ��fIT(i�'cI(J C� I ` PHONE �S� ••� �/ CONTRACTOR �I_� �^ �-•�g CONTRACTOR ADDRESS1l� _CITY/STATE/ZIP<• LICENSE ❑IIC-42 111C-36IC-36 OTHER . NUMBER Gi6''&3-5'Lf� XPIRATIONDATE_b 1C /r TTl I + WATER TABLE DEPTH: 1 V (/O ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # _- LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ✓RFPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT-(jr-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: &I-61ESIDENCE I I COMMERCIAL I I OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP CAPACITY _ gal # OF COMPARTMENTS CAPACITY _ gal # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINE ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) (& LEACH LINES ❑ LEACHING CHAMBERS NONE ■ ... ■ NOON■ EEEe ■■■■■ppppp ■■■■" ■ ___ # OF LINES LENGTH OF LINES ��r It ■E■ME■■E�7■UEN ■■!!N®N■N■■■■rp ■■MMNEN■N■E■ ■■N■■■■■■■■■■■E■■E■E■ DISTANCE TO NEAREST WELL_1._� ` It FOUNDATION 41a, _ t ft PROPERTY LINE ft ❑ FILTER BED WIDTH _ ft LENGTH _ ft DEPTH ft ■■N■NON■N- DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH _ ft DEPTH ft DISTANCE TO NEAREST WELL It 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 ft DEPTH ft DISTANCE TO NEAREST WELL ft 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. SIGNED 'OR INSP�ECCTIIO�N,S� - PLEASE CALL (209) 953-7697 TITLE -_. ✓y±� T i 'f'RI DATE II I ■■■■■■■■■■■NEE ............. ■■■■■■■■■E■■■■ EN■■■■■■■■■■IN ■■■■■■■� �■�!�� SC NONE ■ ... ■ NOON■ EEEe ■■■■■ppppp ■■■■" ■ ■.�.. .■■■■■■W■■■■■ p �.■■ !1■LINEN■■■■NEE■■■ 21. -MIN. ___AkINE■ ■■II►I■■ ■■ ■■■ §M ■■■■ g■O ■■■®EEE■■ VAME ■■■RE■NNE 19■■ N ■E■ME■■E�7■UEN ■■!!N®N■N■■■■rp ■■MMNEN■N■E■ ■■N■■■■■■■■■■■E■■E■E■ INFO ■■EN■■ NOON■E NNElrl\pE NONE N ■O E�■■■N■ CELE\1 N ■ RE I■■■ E■N■N■ ■■■■E■NE■E■E ■■■■■EIIE■■■■ NOON■■N■NN■EN■NN■■■■■■■■ ■�1I■►1N E■E■■ENE■E■E. ■I■EENENNN■■■■ ■■N■NON■N- ■■■■r■■■■■■■■EE■■■■ ■EMMEMEN■E■■■■100MEM■■ E■OEM■■N■■■N■E N■■. ' N E■ ■ ■■ ■ ■■■■■E■E■■■■ ■■■■EEE■■M■ D E PA R TALENT SE10 NY Dr Application Accepted _ �� B . 0 �_ _. Area _�� " 1 Employee ID ' Final Inspection By SPP�+� _ Date 3 f D SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Sdfes ___ Pit/Sump Soil Character: COMMENTS�I�L��W PE SC Received Check#/ Amount Code INFO By ash Remitted Dat 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 Permit/ Service Request # Invoice # Permit ID# _ 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17