SR0077072 - Laserfiche WebLink

Home Browse Search

0q - ONSITE WASTEWATER TREATMENT 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 ��/ EXPIRES 1 YEAR FROM UATE ISSUE] JOB ADDRESS �s1fid! %L% / /j�iCSCr�C1 �� %C�ITY/ZIPh /aj of CROSS STREET �b APN �/(C� � V 6 V J PARCEL SIZE _�_ OWNER NAME /h/er:\(Il PHONE -� RESS OWNER ADD ---CITY/STATE/ZIP�� CONTRACTOR Geirj.sG l `�e/ih PHONE 3Gy"S0z! CONTRACTOR ADDRESS LICENSE . ie -42 11 C-36 OTHER .'e2-1 I w'1 CITYISTATE/ZIP NUMBER VJ !aT -5— EXPIRATION DATE WATER TABLE DEPTH:y 1% �tyv ft GEOGRAPHICAL INFORMATION: Coordinates X _ Y ❑ PERC TEST # BUILDING PERMIT # - _ _ LAND USE /APPLICATION # TYPE OF WORK: >C� NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTER ATIVE REPLACEMENT --- OUT -OF -SERVICE SEPTIC SYSTEM ^ DESTRUCTION'G-.,,,-��/�� INSTALLATION WILL SERVE: 0f, RESIDENCE 11 COMMERCIAL IJ OTHER ----- NUMBER OF LIVING UNITS: _� NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: - SEPTIC TANK TYPE/MFG 1 _ CAPACITY �a� </G gal # OF COMPARTMENTS____ ❑ GREASE TRAP TYPE/MFG _ _ CAPACITY —__ gal # OF COMPARTMENTS _ ft DEPTH ft DISTANCE TO NEAREST: WELL .10V ft FOUNDATION —_�y fl i PROPERTY LINE S _ ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) Fif— LEACH LINES LEACHING CHAMBERS # OF LINES � LENGTH OF LINES y0 ft Invoice # Permit ID# DISTANCE TO NEAREST WELL aS-' ft FOUNDATION /10 r ft PROPERTY LINE _ ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft 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 -,2 _ WIDTH '36 r _ft DEPTH a s J ft DISTANCE TO NEAREST WELL 30 ft FOUNDATION ro ft PROPERTY LINE_ _ It 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 B_ % Final Inspection By _—_-- Date__. '<2 4 � Character of Soil to ept 3 Ft._ _ _ Pit/Sump Soil COMMENTS %� A� -_L 6 DATE f % Area Employee ID#� u ❑ SPE IAL PERMIT - Approved by Lk PE SC Received Chec Amount Date Permit/ Invoice # Permit ID# Code INFO B Remitted Service Request #evnU 7-;L uhK Ie. +0 010WVP n or tu- or d:rec� cmAj;;k;Vj6y\to Sef-v;�nor a C ea+\ 0' �t+yr;2 NSITE WASTEWAT R TRTMNT S ST M FERMI f a/2an2 �� " �s r�o Sv.rJQeec;Ac l,q'u:� a-� #�k I r\� S w!�¢a �oIets aae-F1'.s�ad � S'. k,�.�t,et ,5 k+�Qk rAnr�,+k). VP «' go-itwIvy v�,ln9�r s�ak+?� ,Ilea ld �t�� WAS d- ., A6Q\'K+ereCL ,CHx"nS 3 ev'), tet 124/Zol g . Copy a� �h;s �e�m;t :s rnQ.lg �� o�►�tkr qbo r� ctaar Sg ,�