SR0079073 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER THEATMENT SYSTEM PERMIT P-` SAN JOAQUIRCOUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDAB E PERMJT CALL 209 5-7697FOR INSPECTIONS EXPIRES 1 AR FROM DATE ISSUED JOB ADDRESS ��,s CITY/ZIP 1 061-0710 7� CROSS STREET l }��a / .� 9APPN�`� ..�-1w1� ..��f�� ✓PARCEL SI�ZEr�1 • OWNER NAME ! ',16 A ~e 6� 11�= csr= - 1 W �!1 c PHONE269 r ✓9 �✓0C13 OWNER ADDRESS � `, C) ✓ � + u- ��-rly� AL1 +CITY/STATE21P ~ CONTRACTOR l `� ✓(Ji�� C ---PHONE 466 -96, /� /(]��-��I CONTRACTOR ADDRESS CITY/STATE/ZIP CSU �-^ CA LICENSE \,$11' IC -42 11 -IC -36 OTHER A. NUMBER ion 1 EXPIRATION DATE 4 I-' WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y CI PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION C7 REPAIR/ADDITION ENGINEER DESIG ED/ALTERNATIV '+ REPLACEMENT 11 OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION ❑ LEACH LINES ❑ LEACHING CHAMBERS Received B he ash INSTALLATION WILL SERVE: 4 '� RESIDENCE ❑ COMMERCIAL ❑ OTHER Invoice # NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: _117gal ft SEPTIC TANK TYPE/MFG �V �-. CAPACITY # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS 607 10 1 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 Received B he ash # OF LINES Date LENGTH OF LINES ft Invoice # DISTANCE TO NEAREST WELL ft FOUNDATION " ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY I" ft fAYAft ❑ MOUNDED WIDTH ft LENGTH It DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPER T ft ❑ SUMPS WIDTH ft LENGTH _ ft DEPTH ft V DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT H ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH qAhp ft fN DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPER COU ft ❑ SEEPAGE PITS NUMBER WIDTH _ ft DEPTH HEALTH OEPA 1i 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. R fvy I.� r.Cr'_1�11:73�13i1�1�`rEC SIGNED L A-V L.X-J ',,-J C'� t_� `y - TITLE II%)i�''�L°L%�u -_ DATE J I !'r 1 L � Application Accepted By Final Inspection By Character of Soil toeptl COMMENTS //%� 6❑ SPECIAL PIERMIT - Approved by Soil Character: T PE SC INFO Received B he ash Amount emitted Date Permit/Cod Service Request # Invoice # Permit ID# ,CS- " 07 3 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17