SR0080025 - 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 209 953-7697 FOR INSPECTIONS EXPIRES 11 FROM DATE ISSUE[ r� JOB ADDRESS �T!-� /-✓%` t cle, ,+ �Y-E�AR CITY/ZIP CROSS STREET .9 ` (OV 6 o f�/✓ APN (7J ✓� PARCEL SIZE S cv OWNER NAME ms's ❑ SUMPS WIDTH ft LENGTH ft PHONE OWNER ADDRESS /�;e" ,- ow � ��i CITY/STATE/ZIP / L �� (`�:!��Y✓ 7 ��C CONTRACTOR J %�!� PHONE DEPTH ft CONTRACTOR ADDRESS CITY/STATE/ZIP I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN LICENSE LJ C-42 I I IC -36 OTHER NUMBER EXPIRATION DATE MIN M48 HOU DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE Uy' DATE 4 z — PERC TEST # BUILDING PERMIT # TYPE OF WORK: I NEW INSTALLATION USE APPLICATION # ENGINEER DESIGNED /ALTERNATIVE REPLACENI T I UUT-UF-SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE I i COMMERCIAL �j I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: l/ NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP CAPACITY CAPACITY ft FOUNDATION ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) V�,► LEACH LINES 1 LEACHING CHAMBERS # OF LINES LENGTH OF LINES ( ft J_ DISTANCE TO NEAREST WELL�??O 61 7t ft FOUNDATION % O ft PROPERTY LINE �ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It 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 ft FOUNDATION 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. MIN M48 HOU DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE Uy' DATE 4 z — Application Accepted By Final Inspection By Character of Soil to Dept COMMENTS 3 TMENT SE N Y yam+ Date Area L Employee ID# Date L2- 111, FI SPECIAL PERMIT - Approved by Pit/ umD Soil Character: 4 PE Code SC INFO Received Check#/ Amount Ca h Remitted Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17