SR0079972 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN Jr AQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL/209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 7�� a w7-1/„�/�IOOAT 1I"/4- CITY/ZIP- 57-0cJ -OW, CA, 9 full to CROSS STREET 5 TI M 5a 14 S'j-- APN 177-19-5-19-00 PARCEL SIZE 3,9 C p q �d OWNER NAME f0 -r .T N/ELS�/1l PHONE /oZS� 997-5.; v� OWNERADDRESSnn �/S01 DG(9L/Ny?'LVV- 26-9 CITY/STATE/ZIP /j2y3Lu4V,�A ?-4540 CONTRACTOR l' N f—:rS N,E)1 CC8 N' LCLI I N� PHONE CONTRACTOR ADDRESS 19 D X 37'14 CITY/STATE21P L_p lac rLLoc� "4-4 9s--361 LICENSE I I IC-42 Ll 1 C-36 OTHER /\G>` NUMBER EXPIRATION DATE At WATER TABLE DEPTH: C ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# V 7A TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: I RESIDENCE I COMMERCIAL 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 It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH rl t q/ ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Yft ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Oil ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH SAN JOAot uh, ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPEFHFA IRONMEWrAl It ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH gRrMENT ft DISTANCE TO NEAREST WELL It 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 CURRENTAND CTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS C PENS AWS. MI I UM 48 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-769 SIGNED TITLE el✓/6 Fi/�4/N 15Fi5-K DATE /Z I( / R til R L E EPARTMENT USE ONLY Application Accepted y I Date 1 Area ' Employee ID# Final Inspection BytW� Date C I I SPECIAL PERMIT-Approved by Character of Soil to 6epth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Che Amount Date Permit/ Invoice# Permit ID# Code INFO By ash Remitted Service Request# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17