SR0079426 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMITCALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FR DATE ISSUED AA JOB ADDRESS JV ; ( V t'p—��V CITY/ZIP L nc,4 v' -i CROSS STREET _ � Wl l e, APN_ � (� ARCEL SIZE _, p 1 v OWNER NAME VX%1\ S"t ru'I S PHONE OWNER ADDRESS I•� �(X�I'y11 8i t/ '?I� CITY/STATE/ZIP �� `Nu `7,S l qo CONTRACTOR PHONE Zo -7 S iD7 CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE I I C-42 C-36 OTHER NUMBER EXPIRATION DATE l WATER TABLE DEPTH: 6,5bs,-, ft GEOGRAPHICAL INFORMATION: Coordinates X Y 1 PERC TEST # BUILDING PERMIT# d LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION � �QI INSTALLATION WILL SERVE: RESIDENCE L.! COMMERCIAL L OTHER �r NUMBER OF LIVING UNITS: (� NUMBER OF BEDROOMS: 13 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG T CAPACITY © gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELLt T ft FOUNDATION t ft PROPERTY LINE i ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES "T ft 1 DISTANCE TO NEAREST WELL .T ft FOUNDATION ft PROPERTY LINE + 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 ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH- It '/ DISTANCE TO NEAREST WELL ft FOUND A ION ft PROPERTY LINE ft -E/ E SEEPAGE PITS NUMBER WIDTH Sit ft DEPTH ft / \ i DISTANCE TO NEAREST WELL I T 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!�tll ON LAWS. MINI UMOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-7697 SIGNED TITLE O'vhGi DATE Z0'( A it Ile i w-f i 1� 5 o PAR.- j r PARTMENT USE ONLY I-� Application Accepted By NT,7LA Date Area Employee ID# W Final Inspection By Date n SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft:_ Pit/Sump Soil Character: ._ COMMENTS PE SC Received he Amount Permit/ Code INFO B Cash Remitted Date Service Re uest# Invoice# Permit ID# 21 i �a 5--S4 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17