SR0079552 - 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 9.53-7697 FOR INSPECTIONS EXPIRES 1 YEARFROMDATE ISSUED JOB ADDRESS �V CITY/ZIP L Sa 3 CROSS STREET I -5t- APN )L ✓ v PARCEL SIZE p OWNER NAME 1 Yao' -J c�P)H/ONEC OWNER ADDRESS SV I J / _ CITY/STATE/ZIP CONTRACTOR _ PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE C-42 i I C[-`36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ti J _ ft GEOGRAPHICAL INFORMATION: Coordinates X PERC TEST # BUILDING PERMIT#—. LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGN D/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION L INSTALLATION WILL SERVE: !J RESIDENCE L 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 It 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 ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL _ It FOUNDATION It PROPERTY LINE It ❑ SUMPS WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It 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 COMPENSA�TIION LAWS. I MI UM�O ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE U W i 1 C DATE (r-2-31Y T AFD _ ic ?018 AL Z ZOO O COUIV7.y M NT s D RARTMENT USE ONLY Application Accepted Date -16 Area Employee ID# AhMeal Final Inspection By- Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: _ it/Su p Soil Character: COMMENTS C On nC( I; r n PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO ash Remitted ervice Request# I), () 06,14— 42-01 ca �/ 4) // nL ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 OBJ VV6