SR0079379 - 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 PERMIT CALL 209 953-7697 FOR INSPECTIONS / , I EXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESS, 164919 Aly A� -e CITY/ZIP _f�/�! 2;;F;9gz) CROSS STREET R,' 'V 2 T� APN O U o O PARCEL SIZE OWNER NAME f� /G 5 /T 1 y' ,G� 'L /G C ! j 1 ` �1 1�� Q AGi PHONE a ` �� ! 7 T / OWNER ADDRESS LAV%O/! y26 P1ne. &I 2 �oCJ[ 9� �TU n � Gp/ I� CITY/STATE/ZIP CONTRACTOR b0� � l ezo- w PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE I I C-42 I I C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: 1,-7s ft GEOGRAPHICAL INFORMATION: ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION REPAIR/ADC Coordinates X Y LAND USE APPLICATION # REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM '� DESTRUCTION -f0 f INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL _7 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK ❑ GREASE TRAP ❑ LIFT STATION TYPE/MFG TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP CAPACITY CAPACITY ft FOUNDATION ❑ PKG TX PLANT TIVE d gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES fi DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE fi ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl ❑ MOUNDED WIDTH ft LENGTH ft DEPTH f1 DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE fl ❑ SUMPS WIDTH ft LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH fi DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE f1 ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH f1 DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE f1 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 COMPENS/ION LAWS. M1NJMUM.2,rH0UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLEabT-1"P-%c- DATE UAH I IVIGW I UJC U N L r /` ) Application Accepted By Date Area L) ` G Employee ID# Final Inspection By Date 1 5 SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS } PE Code SC INFO Received B Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 'I11 S 7 CrA- �S} -7 111 5P-66-7 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 r