SR0079142 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT GALL 20 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM D E ISSUEI JOB ADDRESS In / _ Q / 2-t^rt CITY/ZIP Ae CROSS STREET ^ �� / �) 1 / 22 APN ;'� PARCEL SIZE OWNER NAME eer ,o ft PHONE ft iI FILTER BED OWNER ADDRESS ft LENGTH CITY/STATE/ZIP It DEPTH CONTRACTOR �� r��-� /� �T G 1l�Q� PHONE s� WELL ft CONTRACTOR ADDRESS /� �y V / CITY/STATE/ZIP !�' / / a��` • / J �� LICENSE I C-42 I i C-36 OTHER NUMBER EXPIRATION •.Almon IAOLc vcrin. Y v R 1. LUUt1Arr11l,AL MrUtIMA 11VN; V00(U111d1C5 A T ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: B' RESIDENCE ❑ COMMERCIAL�j LI OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: / NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFTSTATION SIZE TYPE OF PUMP CAPACITY CAPACITY It FOUNDATION _ ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ 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 !2091953-7697 SIGNED �-- TITLE/ DATE Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: C 0 M M E N T S TI. 44y✓ /�7L 11 7jQ2 PE Code SC INFO Received eck#/ Amount Rem' ed Date ❑ LEACH LINES LEACHING CHAMBERS Permit ID# YOF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft iI FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION fO r It PROPERTY LINE �� ft ❑ MOUNDED WIDTH ft LENGTH It 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 it 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 COMPEN /'ION LAWS. MINIMUM,HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL !2091953-7697 SIGNED �-- TITLE/ DATE Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: C 0 M M E N T S TI. 44y✓ /�7L 11 7jQ2 PE Code SC INFO Received eck#/ Amount Rem' ed Date Permit/ Service Request # Invoice # Permit ID# ff�o� 1z / - 1 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 a a1 'i