SR0080241 - 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 PERMIT �CALL(2091953-7697 FOR INSPECTIONS/.� ExPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �• CJ Jt`�N CITY/ZIP /S&i f / '� �i 7��-3 =1 I In CROSS STREET//)� ..} �^j L y^ APN '- • _ �) PARCEL SIZE �)�/ p OWNER NAME/T l>�e✓�C (y►^�+-C h 1111 f G t'^H S -'Y1 C ,Ay PHONEJ��.,V q �S OWNER ADDRESS..^^� 0!t S' /Y CI'_S' C I I�1 /� e j CITY/STATE/Z�I-fP /(`Ll 4I -e-c t, CONTRACTOR 0'e ku L� �l0�t �rU C/j/LJ V/ 1 PHONE L I`-C* 7` CONTRACTOR ADDRESS l L)2, 4 /Lf `C rF /Ice 4t C't. 1/ CITY/STATE/ZIP J -R C/cT-C ✓� l El ��/`S-- �' LICENSE Y. C-42 I,GC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y CERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: .. NEW INSTALLATION ❑ REPAIR/ADDITION - ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I I OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: I1 RESIDENCE I COMMERCIAL i' OTHER NUMBER OF LIVING UNITS: 12— NUMBER OF BEDROOMS: 2-- NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE 1t ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES, LENGTH OF LINES ft DISTANCE TO NEAREST WELL _ft FOUNDATION_. J_ft PROPERTY LINE_ ft ❑ FILTER BED WIDTH ft LENGTH tt DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. —`- 11 48,hj�UR ADVANCE NOTICE REQUIRED FOR INSPECTION 4_81GNED TITLE Y'l'`�S l C'� V1"t RE CE�V�D mvjo NVIRO UI N L; Ty U p t DEPARTMENT SISE ONLY A Application Accepted By YL� Date = / Area ' Employee ID# /Y U� Final Inspection B A ri a Date Cl SPECIAL PERMIT-Approved by Character of Soil to DepRh`bf 3 Ft: I Pit w p Soil Character: COMMENTS PE SC Received Check# Amount Date Permit Invoice# Permit ID# Code INFO j31fA as Remitted S rvice Request# 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18