SR0079669 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT e✓ SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CA 09 953-76.97 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 5100 ebRs+ ?o-;,T— KP QU CITY/ZIP Z O PT ~CROSS STREET APN -7 PARCEL SIZE p I/I n4dr M4,l�Lt�jfJ v OWNER NAMI&J-1`5ow j rn fAeoe, hyi> PHONE M OWNER ADDRESS �iLJC� - �nir/�C CITY/STATE/ZIP 0 CONTRACTOR)l W,ys-rit 1.1GYSD✓✓ S S-0�� --r PHONE( ffi CONTRACTOR ADDRESS ro` .96>1 9'(., M CITY/STATE/ZIP LICENSE -42 11 C-36 OTHER NUMBER Y 2 G eI34 EXPIRATION DATE WATER TABLE DEPTH.V0 Yo ft GEOGRAPHICAL INFORMATI N: Co dlnates X Y J PERC TEST # BUILDING PERMIT#rfj dTU AU LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION PAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE LL COMMERCIAL rJ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG ��L Co"U(-(x1='TC CAPACITY 15-00 gal #OF COMPARTMENTS Z ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL loo-4- ft FOUNDATION �Oft PROPERTY LINE t ft ❑ LIFT STATION SIZE TYPE OF PUMP _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES � LEACHING CHAMBERS T+" M"/zA� #OF LINES `3 LENGTH OF LINES ga ft DISTANCE To NEAREST WELL 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 It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH 3��` ft DEPTH -z ft DISTANCE TO NEAREST WELL ft FOUNDATION Ibr ft PROPERTY LINE S} 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. MINIMUM OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE /�1ZFSrD�Nr DATE O"I/91/1 4 to W 14 v aSAN ,� Z EVip PATE EPARTMENTUSE LY Application Accepter!By Date ! Area Employee ID#� Final Inspection By Date L ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Check#/ Amount Permit/ Code INFO B Cash emitted Date Service a,,quest# Invoice# Permit ID# �bn4a(A-4d 9120 g' 5Q DD-5 v t,(o 3080TVV 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17