SR0079023 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 (VUN-PIEFUNDABLE PERMIT ^ GALL 21519 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESS �� /2��' :� Z. /� CITY/ZIP � / ' CROSS STREET v �V►`� APN // /✓(� �/� i `II4 ARCEL SIZE OWNER NAME �Cr�� D�, �r J1Z�T7 it - PHONE 8 OWNER ADDRESS �c/c'�%�" `� CITY/STATE/ZIP CONTRACTOR 19112)1-. Q K e- y�" PHONE CONTRACTOR ADDRESS V-b�CITY/STATE/ZIP i7�7 CJ1� �-4 LICENSE C-42 C-36 OTHER NUMBER Ir —73 f �5 Ai. WATER TABLE DEPTH:{I ��L) ft GEOGRAPHICAL INFORMATION: Coordinates X Y F7PERC TEST # BUILDING PERMIT # _ LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION -o REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION ❑ SEPTIC TANK TYPE/MFG �L �M `�� CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS Permit/ Service Request # DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES�C j C) r ft DISTANCE TO NEAREST WELL ft / FOUNDATION ft PROPERTY LINE �— ` ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL /0c7 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 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. rv►nvnv#Lr#v# f a "vvML.'VM#v%.c IYV IILrc mcwUIr7CU rurs IIYJrCI.IIU/Va - r'LCAJC L.ALL (LUVI Voj-/oy/ SIGNED y q TITLE DATE �7 G. EPARTMENT SE ONLY Application Accepted By Date Area Employee ID#� Final Inspection By Date 2 D SPE IAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pi ump Soil Character: COMMENTS PE Code SC INFO Received Check#/ Amount emjtte A Date Permit/ Service Request # Invoice # Permit ID# � 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17