SR0080587 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(299)458-3420 NDN-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOBADDREss yLPg2 CO`�M G`� 112. CITYIZIP W--rt7 rJ _A =a CROSS STREET C--I'�a.,ti 1 R J G APN (� Y 6 D !�-3 Iy� PARCEL SIZE , 2 a OWNER NAME F-'-'I-tAMEl 7ETCLOt=I-P PHONE OWNER ADDRESS''rt SRTE CITYISTATEIZIP CONTRACTOR ��/� COili;rk VzTdsorU i Sev TNL PHONE CONTRACTOR ADDRESS ':REEK D-D- CJ{Y Z-Z CITYISTATEIZIP Lin^t`✓T/� ZfF' Sig t'$ LICENSE E45t-42 DOC-36 OTHER NUMBER r 2�y EXPIRATION DATE WATER TABLE DEPTH: fi GEOGRAPHICAL INFORMATION: Coordinates X ! V ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: U NEW INSTALLATION REPAIRIADDITION U ENGINEER DESIGNED]ALTERNATIVE REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: SEPTIC TANK TYPEIMFG .INS=LTi'!-:pR i53ca CAPACITY /S-j . gal #OF COMPARTMENTS Z- QI GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft E) LIFT STATION SIZE TYPE OF PUMP E3PKG TX PLANT CI SAND OIL SEPARATOR(ENCLOSED SYSTEM). LEACH LINES PS LEACHING CHAMBERS-;UW-e'�-147--vI`nr #OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL 4404ey— hft FOUNDATION 20 It PROPERTY LINE S ft D FILTERSED WIDTH It LENGTH ft DEPTH ft DISTANCE To NEAREST WELL it FOUNDATION fl PROPERTY LINE ft D MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft D SUMPS WIDTH fl LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION ft -- PROPERTY LINE ft 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE-TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ,7110It DEPTH 2s, ft DISTANCE TO NEAREST WELLA70 L'rafl FOUNDATION Zoe ft PROPERTY LINE s I 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. MINIMUM 3H DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE� DATE IIs�S/I°I 111111!%ell'%;4401 DEPARTMENT USF40NLY Application Accepted By Date• Area ployee ID# Final Inspection By Dato El SPECIAL PERMIT-Approved by Character o//fr1�}oil t Depth of 3 Ft: Pit/Sump Soil Character: COMMEtyjlB ��r7 4a PESC Received hock Amount Date Permit/ Invoice# Permit ID# Code I FO By ash Remitted Service e e t# u ago ov 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 424/12