Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT re --" - <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />IVUN-tIEFUNDABLE 1'ERMI1 <br />401lR-71y <br />GALL (2U.9).953-7697 FOR INSPECTIONS _ I I _ EXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS " "CITY/ZIP C/k0% O U-5 4— <br />CROSS <br />CROSS STREET ��^J 1 /k l` //-_,,,� //(�APN Y�D�� �� ,f''/' �3] PARCEL SIZE <br />�/ ^� � <br />OWNER NAME L4eLle A MI'U/lY.l j� � / Y � I �%(•/ U01,4t PHONE <br />OWNER ADDRESS "G I / �'^ L CITY/STATE/ZIP <br />CONTRACTOR I�GVL �i I V f 4 /""/ 'f/ C PHONE 15`o Cl — 13 `f t SO1;;L7 <br />CONTRACTOR ADDRESS—c9-?/ (e O /J-.0 .1 )P,-. CITY/STATE/ZIP LqCd' <br />LICENSE 1 X-42 [I C-36 OTHER NUMBER EXPIRATION DATE /'J U ! �/ <br />WATER TABLE DEPTH: <br />f <br />It U ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />Li <br />PERC TEST # <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br />Permit ID# <br />4-;,(J <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION <br />WILL <br />SERVE: RESIDENCE ❑ COMMERCIAL Ll OTHER <br />%{ <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />/ <br />TYPE/MFG C(� I� L CAPACITY /'PQ V gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />SOD 3o <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />�l <br />LEACH LINES <br />LEACHING CHAMBERS # OF LINES 3 LENGTH OF LINES SS ft <br />DISTANCE NEAREST lOO / (90 0130 , <br />TO WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH ft DEPTH It <br />DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br />❑ <br />SUMPS <br />WIDTH ft LENGTH ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS <br />NUMBER 3 WIDTH qcp ft DEPTH c95 It <br />DISTANCE TO NEAREST WELL /SD ft FOUNDATION l ft PROPERTY LINE 30 ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MINIMUM 24-HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED TITLE IL '— DATE Zi -//-4? <br />DEPARTMENT US ONLYVM&1M DF_ <br />�......_. - EMT <br />Application Accepted By Date Area Employee ID# /" <br />Final Inspection By Gi Date / ❑ SPECIAL PERMIT- Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character:+a/?� r�� <br />COMMENTS (­OVJ ( AiM 1- p*'i(Oo�/ TZ� 11 <br />PE <br />SC Received <br />INFO B <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/Code <br />Service Request # <br />Invoice # <br />Permit ID# <br />4-;,(J <br />(lam <br />UP, <br />$7,L <br />%{ <br />S<--—�S <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />