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SR0079548
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4200/4300 - Liquid Waste/Water Well Permits
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SR0079548
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Entry Properties
Last modified
9/12/2018 9:26:06 AM
Creation date
9/12/2018 9:24:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0079548
PE
4211
STREET_NUMBER
12439
Direction
E
STREET_NAME
ATKINSON
STREET_TYPE
RD
City
LODI
Zip
95240
APN
06323047
ENTERED_DATE
8/23/2018 12:00:00 AM
SITE_LOCATION
12439 E ATKINSON RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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E <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697FOR INSPECTIONS EXPIR <br />/E <br />�S 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS U �JCITY/LP /,,LL l <br />CROSS STREET _ bbard APN 3 _ �,3O - 0T2 PNKXLSM &- <br />OWNER NAME 4001 <br />/ -PHONE <br />] '`r <br />OWNER ADDRESS JJ _ CITY/STATF/AP 40 .0 1 J -% <br />CONTRACTOR PHONE aO ��_�J?CD y �O�/ _ <br />CONTRACTOR ADDRESS p'� 3I� " -�N �Y. N_ �_ CrrY/STATEi6P �/0� ' �b <br />LICENSE X-42 C-36 OTHER, NUMBER_�sq�� EXPIRATION DATE / 51 - <br />WATER TABLE DEPTH: Cu �v� ft GEOGRAPHICAL INF MATIOrn_ CODrdID3tes X _ _ Y <br />PERC TEST # BUILDING PERMIT # Ti ` AND USE APPLK:ATION # <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: REMWENCE COMMERCIAL //� OTHER <br />NUMBER OF LIVING UMTS: NUMBER OF BEDROOMS:Qyn/��/ NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPFIMFG c CAPACITY /(J{JO gal # OF COMPARTMENTS_ <br />❑ GREASE TRAP TYPEIMFG CAPACITY gal # OF o LL COMPARTMENT -S7 <br />DISTANCE TO NEAREST: WEft FOUNDATION ft PROPERTYLINE 3O ' ft <br />❑ LIFT STATION SIZE _ ____ TYPE OF PIMP _ ❑ PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />LEACHING CHAMBERS_ <br />#OFLINES 3 <br />LENGTH OF LINES <br />I <br />G I <br />, <br />r <br />310 <br />30 <br />DISTANCE TO NEAREST <br />WELL -/ <br />It FOUNDATION <br />It PROPERTY UNE <br />ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />It PROPERTYLINE <br />It <br />❑ <br />SUMPS <br />WIDTH <br />ft LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY UNE <br />ft <br />❑ <br />DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROP�EJRTY NE <br />ft <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />4/ " <br />ft DEPTH (� � <br />ft <br />DISTANCE TO NEAREST <br />WELL 000 <br />p <br />it FOUNDATION 460 <br />ft PROPERTY UNE <br />30 7 <br />ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE <br />WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />Character of SDI[ to Depth of 3 R: Pit/Sump Sol] Character: _ <br />COMMENTS <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />
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