SR0079641 - 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 PERgq 4 CALL 09 953-7697 FOR INSPECTIONS EX IRES 1 YEAR FROM DATE ISSUED JOB ADDRESS CITY/ZIP UfDi V CROSS STREET APN 0 6 I- L'0-33 PARCEL SIZE p OWNER NAME l[�/� `�`�� PHONE2-1O -'1 I3 cin OWNER ADDRE•SS� OJ��-lJ 17��^ OD CITY/STATE/ZIP LLC;i /��5� y CONTRACTORD. A �(4 (a1 / o `�, t\� c PHONE UIJ��-7'�Q�J CONTRACTOR ADDRESS N V�I�V N UJ 1 ' --CITY/STATE/ZIP(3DCifl�j - V .JL�JS LICENSExC-42 I I C-36 OTHER NUMBER WON I EXPIRATION DATE�� WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINE �,( LTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTR T N (� INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL CI OTHER NUMBER OF LIVING UNITS: c NUMBER OF BEDROOMS: NUMBER OF'E O S: ❑ SEPTIC TANK TYPE/MFG 64 >-rtf J/T CAPACITY gal �E(aF CrOOMPARTMENTS IU ❑ GREASE TRAP TYPE/MFG CAPACITY gal Ii~��lV��Jru to-w DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROF' dA TM@y7! ft c-rr� ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) _ .____............... ....-_ LEACH LINES LEACHING CHAMBERS ro 2A #OF LINES LENGTH OF LINES A-Q ft C� DISTANCE TO NEAREST WELLQ ft FOUNDATIONft 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 A WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH 1F"ft LE PTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 150 ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL _ ft FOUNDATION ft 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 COMPENSATION LAWS. M H U V ICE REQUIRED FOR I TION - LASE CALL (2091953-7697 SIGNED TITLE DATE s r• ,4.0, p DEPARTMENT USE QNL Ylg I Application Accepted By Date Area Employee ID# J (,j Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: __- Pit/Sump Soil Character: COMMENTS PE SC Received h ck# Amount Date Permit/ Invoice# Permit ID# Code INFO B --// Remitted Service Re IueiSt# Ce ks w —� � LP LA k 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17