SR0079098 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT I J'a SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMITS � V D CALL JOB ADDRESS CROSS STREET OWNER NAME l7/ 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE] CITY/ZIP t"_ wpa, i -V 1115 w.:7 �- APN G U S 3 9 au L► 'r PARCEL SIZE 1./13 PHONE OWNER ADDRESS s C-1 M C CITY/STATE/ZIP �j �j �^ CONTRACTOR V G PHONE po / �� / Jo:;) rr CONTRACTOR ADDRESS ®ey& a ll�_ _ _ CITY/STATE/ZIP LICENSE I7XC-42 ❑ C-36 OTHER NUMBER J /0 f�_ EXPIRATION DATE WATER TABLE DEPTH: e ft GEOGRAPHICAL INFORMATION: PERC TEST # BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION LA. REPAIR/ADC Coordinates X Y LAND USE APPLICATION # IN ENGINEER DESIGN-E�D^ /ALTERNATIVE X REPLACEMENT I U A OUT -OF -SERVICE SEPTIC SYSTEM A, DESTRUCTION 1 (A mO �L INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL + J OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY A gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL 5O ' ft FOUNDATION CY �/ , ft PROPERTY LINE 60 , 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 COMPEN ION LAWS. MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED �� TITLE_6wA9 �f DATE S `�0- e Application Accepted By ' Final Inspection By Character of Soil to D th 3 COMMENTS i r -DEPARTMENT USE ONLY J Date_ S- 110- t Area / 01 Employee I D# Date ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: r .An PE Code LEACH LINES LEACHING CHAMBERS _ Amount Remitted Date # OF LINES 3 LENGTH OF LINES �`./7 ' ft Permit ID# DISTANCE TO NEAREST WELL -J 0 ' ft / FOUNDATION 0 If Y ft PROPERTY LINE 7'�' ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ 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 12l SEEPAGE PITS DISTANCE TO NEAREST WELL NUMBER �f WIDTH * ft /I FOUNDATION ft ft PROPERTY LINE ft DEPTH v�� ft DISTANCE TO NEAREST WELL 14-V ft FOUNDATION A001 ft PROPERTY LINE �U 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 COMPEN ION LAWS. MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED �� TITLE_6wA9 �f DATE S `�0- e Application Accepted By ' Final Inspection By Character of Soil to D th 3 COMMENTS i r -DEPARTMENT USE ONLY J Date_ S- 110- t Area / 01 Employee I D# Date ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: r .An PE Code SC INFO Receive Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17