SR0080037 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 ' NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS I(o "F S. LAWkE,QCE 12-7c,- CITY/ZIP ESC-F11-0"j CROSS STREET �(ZTWV 1� APN ��'( �o4o - O 4 PARCEL SIZE Z•4 w y 0 OWNER NAME C+W—IST/NAI r1 r'm o5 oy) G PHONE U-+'i -- �aG/� OWNER ADDRESS 2,x314(e J SSSS/TC..-Af/ CI,�IZ• �,p. CITY/STATE21P ` � CA ` K3.'-o CONTRACTOR L-I\ L�tt��O I-�� Gli�'<-^•�y 11�-yNY�v`•' 1 r�L PHONE CONTRACTOR ADDRESS -TO-q W • OAK— ST• CITY/STATE/ZIP 1--6P I CA C)5 If C7 LICENSE LC-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: i.I NEW INSTALLATION I REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE II REPLACEMENT LI DESTRUCTION INSTALLATION WILL SERVE: L RESIDENCE COMMERCIAL L OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 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 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL It 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 It ❑ 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 It PROPERTY LINE It 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. INIMUM 2 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 G SIGNED TITLE CCNjVI.j e%rV'T DATE 84 JQq QV1N C FAgR��rY DEPARTMENT USE ON Y fA Application Accepted By ^� Data Z z 1 1 Area _ Employee ID# AL-S Final Inspection By Date G� SPECIAL PERMIT-Approved by Character of Soil to Dabth of 3 Ft: Pit/S.4 Sail Character: CQMMENTS tai S 1 Y S� �&P�19 PE Sc Received hec Amount Date Permit/ Invoice# Permit ID# Code INFO sh Remitted Service Re uest# 22 Z 1 fl/J/11500027 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT