SR0080110 - Laserfiche WebLink

Home Browse Search

' ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JUAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 20c9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 69-n3 f- 0 / 1/0 O ✓ <-- /fit-! VCITY21P Z,14-nqowo' CROSS STREET �L ! I erZ0 4G1 APN / PARCEL SIZE OWNER NAME ,/PZ__ JU /ht/WA—� /�PHOrNE OWNER ADDRESS O O>/ CITY/STATE/ZIP 060 CONTRACTORq ( nG PHONE ?o //r,3� CONTRACTOR ADDRESS '2j✓/6 /'J�h I r CITY/STATE/ZIP60 / J1_)_ !> LICENSE U42 I II IC-36 OTHER NUMBER Q 5 EXPIRATION DATE X WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y tf i PERC TEST # BUILDING PERMIT# LAND USE APPLICATION TYPE OF WORK: 11 NEW INSTALLATION REPAIR/ADDITION ENGII4E QIGNED/ALTBhNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTR 7J �?Uliy INSTALLATION WILL SERVE: RESIDENCE I_I COMMERCIAL 1_I OTHER H D= AL NUMBER OF LIVING UNITS: .1-- �NnUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: r ❑ SEPTIC TANK TYPE/MFG S ��O W CAPACITY /6�O gal #OF COMPARTMENTS a ❑ GREASE TRAP TYPE/MFG J CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS 10 64n"6e/J #OF LINES LENGTH OF LINES / ft DISTANCE TO NEAREST WELL l ft FOUNDATION_z- Q It PROPERTY LINE It ❑ 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(C9 WIDTH c ft LENGTH �� ft DEPTH ! / ft i DISTANCE TO NEAREST WELL /S6 " ft FOUNDATION ft PROPERTY LINE V ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE DATE S 4 EPARTMEN USE NLY In� Application Accepted B Date Area Employee ID# VV bs Final Inspection By �"^— Date / Z 11 SPEC AL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS LOINT' - PE SC Received Amount Date Permit/ Invoice# Permit ID# Code INFO Cash Remitted Service Request# a3� 122-0 '9Z i 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17