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SR0080060
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4200/4300 - Liquid Waste/Water Well Permits
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SR0080060
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Last modified
4/12/2019 10:26:55 AM
Creation date
4/12/2019 9:41:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0080060
PE
4211
STREET_NUMBER
17231
Direction
S
STREET_NAME
ENTERPRISE
STREET_TYPE
RD
City
ESCALON
Zip
95320
APN
22921012
ENTERED_DATE
1/8/2019 12:00:00 AM
SITE_LOCATION
17231 S ENTERPRISE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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• ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS / EXPIRES 1 7YEAR FROM DATE ISSUED <br /> JOB ADDRESS h�lt V(! ITIP <br /> j 1 c <br /> CROSS STREET S i C r APN D 1 PARCEL SIZE/ry(, yC� v <br /> OWNER NAME CS fi��� J ei/Yl� ', �PHHONEE S/ -1 V%G <br /> OWNER ADDRESS l S n , Q( C TY/STATE/ZIP f>G�` <br /> CONTRACTOR r N r PHONE A <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP ftnt ll 01 T <br /> ti)LICENSE C-42 L C-36 OTHER NUMBER EXPIRATION DATE <br /> OAN_ JDA IN <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORM TION: Coordinates X E <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICAA D AL <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/AL NATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE I I COMMERCIAL 11 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG --? CAPACITY gal #OF COMPARTMENTS r <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES I LEACHING CHAMBERS #OF LINES ,t0 V LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL 'ZOO ft FOUNDATION l -* ft PROPERTY LINE ff It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER '21 WIDTH `tZ iI ft DEPTH 7- 5— ft <br /> DISTANCE TO NEAREST WELL 150 t ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> IIIA CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 9)53-7697 <br /> SIGNED TITLE DATE <br /> D B � <br /> I 5 <br /> X" <br /> 'VAN will <br /> E ARTMENT SE ONLY wq�,�N� <br /> Application Accepted By ���/ Date 1 Area Employee ID# <br /> Final Inspection By �Q{d�[s�f1!'!M Date 2Illza/ ' H SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> � <br /> COMMENTS PN r�c✓l r ! 22 5 <br /> pr'i �� a��v� ,s rLev� _�dclr�s� . r Z" d //- . <br /> PE SC ReceivedChe Amount Permit/ode INFO B ash emitted Date Service a uest# Invoice# Permit ID# <br /> 21 1 1 1 <br /> 42-01 /• ao ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />
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