SR0079195 - 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 '• CALL (209 953 -7697F -OR INSPECTIONS n IEIXPIIRES 11 YEAR FROM DATE ISSUED JOB ADDRESS 1' I� & G#4 Ai- CITY/ZIP fnztl" - �' Y!' ` s--T-TI6 CROSS STREET `r+1 :is�+A%►� A P N 0 O & PARCEL SIZE 7-1 OWNER NAMES 03-f"'t iq' _ /�� g1PC'fr' Al jr /, (`(G �,� PHONE OWNER ADDRESS I Imo/ I LI MICA CITY/STATE/ZIP R*&2Q! CONTRACTOR M%'(Cre,f3 A—cit `o -c, / ,w- PHONE SL► i7•+ CONTRACTOR ADDRESS —Im 16 O CITY/STATE/ZIP yP ! 41VA'e 4 1 G � •�� ._ LICENSE 11-C-42 [IOC -36 OTHER NUMBER EXPIRATIONDATE t WATER TABLE DEPTH: ' O ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # If 4 jjR � LAND USE APPLICATION # TYPE OF WORK: f/ NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: /RESIDENCE El COMMERCIAL J OTHER } NUMBER OF LIVING UNITS: d..AX NUMBER OF BEDROOMS: 7 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG PtL ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL i(No l ft ❑ LIFT STATION SIZE TYPE OF PUMP Iii' LEACH LINES LEACHING CHAMBERS DISTANCE TO NEAREST ❑ FILTER BED WIDTH DISTANCE TO NEAREST ❑ MOUNDED Q- SUMPS WELL ft ft LENGTH CAPACITY �D. O t, gal # OF COMPARTMENTS_ CAPACITY gal # OF COMPARTMENTS FOUNDATION I, ft PROPERTY LINE :,' ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES FOUNDATION X41 t ft ft WELL ft FOUNDATION WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft f FOUNDATION WIDTH j. ft LENGTH I DISTANCE TO NEAREST WELLI !CIO ft ❑ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ❑ SEEPAGE PITS NUMBER DISTANCE TO NEAREST WELL /� s LENGTH OF LINES IG0 ft PROPERTY LINE IQ 1 ft DEPTH ft PROPERTY LINE ft DEPTH ft ft ft ft PROPERTY LINE ft ft DEPTH inJ ft FOUNDATION '101 ft PROPERTY LINE ft ft DEPTH ID _- ft ft FOUNDATION ft PROPERTY LINE lkl�it t ft WIDTH ft DEPTH 111Ai ft ft FOUNDATION ft PROPERTY4INE Z01V ft WORKERSJOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY p�')W�,tftE S CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE *TOOIEfWL • • UM.,20HOUR ADVANCE• • I FOR INSPECTIONS SIGNED I TITLE 6A xt— DATE■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■_N■■■ �■■i■ice■■■■■■■■■■■■■■■■ ■■■■■■i■■■■I■■■■■■■A INMENNE Sd �■iii■■■■■■■i��._■■■■■■■■■■■■ ■■■■■■■■■ i■■■■■■■ �■�■■■■■■■■■■■■■■w■■■■■■■■■■■■■■iii■■■■■■■■■■ 1 /., / • • PE SC INFO Received B CheckAmount s emitted Date Permit/Code Service Request # Invoice # Permit ID# tQ I SR00-f9 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 Ir cn Y 0 z