SR0079926 - 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 t JOBADDRES�S/10 LEUJ A 1 �� CITYIZIP -f- _ I qoe-y gs304 y yA �y CROSS STREET :- S APN 7-S- V 4L -2 PARCEL SIZE 5 - Art b t� 2 `, v OWNER NAME ��A•CL ftm;�Ih76-S r LLC c/o .31M-('F1z,"IN Or- PHONE k35- X;L'1`'f- OWNER ADDRESS .r4I9.k s/•rT��yo WLV >. �� —CITY/STATE/ZIP -112 r°K--I,CA 953 T+ CONTRACTOR W V E, OAV--t C1 -tQ\A lLo"YKW t r R L� PHONE 3my-03,-+5- CONTRACTOR 3,-+5- p CONTRACTOR ADDRESS 44 O T W C7*K ST.- CITY/STATE/ZIP Lou( -1 S y�f0 LICENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DE IGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL I 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 I LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH It 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 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. MINI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE Ce nIS VC-7 "-r DATE B.C.I.D. LOW UNE CANAL \ / L J I I I En \ T �" RE ES71 V D Y INTERSTATE HIGHWAY �. ROUTE�SNO.S ��/[��///�� `� 10 2418 EPARTNI T U KPI J`C' S SAID Application Accepted By Date Area Employee ID# VAN COV Final Inspection By Date Z C SPECIAL PERMIT-Approved by STN pEpgR L Character of Soil t Depth of 3 Ft: iUSu p Soil Character: IS COMMENTS T PAYME�� RECEIVED PE SC Received Check#/ Amount Permit' NOV ) Q �O�Q Code INFO Ca Remitted Date Service rm uest# Invoice# Permit ID# V V L 8 v N JOAQUIN COUNTY 12 ENVIRONMENTAL HEALTH DEPARTMENT 42-U7 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT