SR0078876 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-HEFUP JOB ADDRESS CROSS STREETV.", V OF OWNER NAME_/�� OWNER ADDRESS CONTRACTOR V"" CONTRACTOR ADDRESS LICENSE C-42 ❑I iC-36 OTHER 9 APN..Q��/C 1' 1 w 4 -S-tr PARCEL SIZE AL Q zm w L& PHONE �9 - f � 0 D` CITY/STATE21P D D) `J 1t 3 ©os Nom. PHONE _"_ J - W !aj W, CITY/STATE/ZIP �f ANUMBER EXPIRATION DATE j_" WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: ❑ PERC TEST #100 BUILDING PERMIT # TYPE OF WORK: I NEW INSTALLATION REPAIR/ADC Coordinates X Y LAND USE APPLICATION # IN ENGINEER DESIGNED REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL I J OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 2— NUMBER OF EMPLOYEES: ❑ SEPTIC TANK ❑ GREASE TRAP ❑ LIFT STATION TYPE/MFG" CAPACITY gal # OF COMPARTMENTS TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP CAPACITY ft FOUNDATION _ ❑ PKG TX PLANT .TERNATIVE gal # OF COMPARTMENTS It PROPERTY LINE It ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. Application Accepted B Final Inspection By_ Character of Soil to D6 COMMENTS �[�5 O ❑ SPECIAL i j�I T MiA f I Character: — MAR 16 2018 w+w JVAUUIN COUNTY TAL HEALTH DEPARTMENT PE Code LEACH LINES I LEACHING CHAMBERS t _zJ;V # OF LINES LENGTH OF LINES �U ft PermiU Service Request # Invoice # Permit ID# 2 L � � �� 5(�M7'Kb DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ft ❑ 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 5(�ft Owl DISTANCE To NEARE T WELL FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH It LENGTH I �Mft DEPTH 7Nft DISTANCE TO NEAREST WELL ft FOUNDATION T ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH _ it 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 It 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. Application Accepted B Final Inspection By_ Character of Soil to D6 COMMENTS �[�5 O ❑ SPECIAL i j�I T MiA f I Character: — MAR 16 2018 w+w JVAUUIN COUNTY TAL HEALTH DEPARTMENT PE Code SC INFO Received BV � Cash Amount Re fitted Date PermiU Service Request # Invoice # Permit ID# 2 �g o3 � � �� 5(�M7'Kb 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17