SR0078939 - 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-REFUNDABLE PERMIT I W UV CALL 209 953-7697 FOR INSPECT►oNs// EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS IG bl%t( CITY/ZIP k, CA- 0 CROSS STREET PVV4 1�1 APN/�/�V 46 G PA CEL SIZE OWNER NAME ' �V Y, PHONE OWNER ADDRESS JCITY/STATE/ZIP (=J CONTRACTOR 7� ' V '/ u �' c PHONE ;)Lo - 4 l�� Sod 7 CONTRACTOR ADDRESS a &of�O% Dri CITY/STATE/ZIP LO LICENSE 1 C-42 1 1 C-36 OTHER NUMBER VS7* fr EXPIRATION DATE WATER TABLE DEPTH: G%Q u u ft GEOGRAPHICAL INFORMATION: J PERC TEST # BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION X REPAIR/AD[ Coordinates X Y LAND USE APPLICATION # REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: / RESIDENCE ❑ COMMERCIAL C OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: D/ALTERNATIVE ❑ SEPTIC TANK TYPE/MFG L)qSI I WI CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS WELL—— ft DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 > SIGNED - TITLE '' DATE F _3 — /f�1 Com' IEPARTMENT US gO N LY Application Accepted By Date Area � Employee ID# Final Inspection By Date ❑ SPECIAL ERMyT - Approved by Character of Soil to Depth of 3 Ft: er PIU mp Soil Character: 1Y.Ir/ COMMENTS ?A- 2018 2018 LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES Tu ft Amount lRemitted Date DISTANCE TO NEAREST WELL—— ft FOUNDATION 30 ft PROPERTY LINE / ft ❑ FILTER BED WIDTH ft LENGTH %� / cJ 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 It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER 3 WIDTH ft DEPTH C15 / ft DISTANCE TO NEAREST WELL/ %D , ft FOUNDATION 3O ! 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 > SIGNED - TITLE '' DATE F _3 — /f�1 Com' IEPARTMENT US gO N LY Application Accepted By Date Area � Employee ID# Final Inspection By Date ❑ SPECIAL ERMyT - Approved by Character of Soil to Depth of 3 Ft: er PIU mp Soil Character: 1Y.Ir/ COMMENTS ?A- 2018 2018 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 PE Code SC INFO Received B y Che Amount lRemitted Date Permit/ Service R�equeest # Invoice # Permit ID# OCl %� / cJ 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17