SR0079112 - Laserfiche WebLink

Home Browse Search

V ONSITE WASTEWATER TREATMENT SYSTEM PERMIT h✓' SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 PION -REFUNDABLE N FERMI (:ALL (�ZU.99bJ-1651 FOR INSPECTIONS �' tXPIRES 1 YEAR FROM UAT ISSUE JOB ADDRESS �39ad ! a P_ !v i CITY/ZIP Feld G V i � �n, CROSS STREET lJ r G I� L; r C APN 3 9 2 S o )b PARCEL SIZE OWNER NAME a � e PHONE �`�—%� OWNER ADDRESS -390O 3 .5 f'on C / � CITY/STATE/ZIP I- G � CONTRACTOR ` A If Ala S1 -e PHONE -.2,0,9 O / O CONTRACTOR ADDRESS / �O / / / CITY/STATE/ZIP !/ CIS 4,oi . dA Q! J 1e LICENSE �42 I C-36 OTHER NUMBER EXPIRATION DATE _,5- J /` 0,2- O WATER TABLE DEPTH: ( tl ft GEOGRAPHICAL INFORMATION PERC TEST # BUILDING PERMIT TYPE OF WORK: NEW INSTALLATION V REPAIR/AD. Coordinates X Y LAND USE APPLICATION # IN ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: F-1 RESIDENCE 1 l COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG Check#/ as CAPACITY Date gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG II CAPACITY a S gal # OF COMPARTMENTS s DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) XJ LEACH LINES LEACHING CHAMBERS k OF LINEST LENGTH OF LINES 567 ft DISTANCE TO NEAREST WELL 1pOf ft _ FOUNDATION Q OD ft PROPERTY LINE D 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 ❑ �>UIVIPS WIETH 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 COMPENSABON LAWS. 148 MINIMUM HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697,y SIGNED TITLE //( �ilaA � DATE '��' / it 1 NP -M Application Accepted By _ Final Inspection By_ Character of Soil to D th COMMENTS l: EPARTMENT USE ONLY V-- Date S- /S - 4 Area Employee ID# A h me Date 0 SPECIAL PERMIT - Approved by Pit/Sump Soil Character: LlJu% 1,•, l � �'�rG �il�/1 PE Code Sc INFO Received By Check#/ as Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# U 10 II a S & s 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 r