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SR0080833
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4200/4300 - Liquid Waste/Water Well Permits
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SR0080833
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Last modified
7/31/2019 9:31:58 AM
Creation date
7/31/2019 9:28:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0080833
PE
4210
STREET_NUMBER
13019
STREET_NAME
CASTLE
STREET_TYPE
RD
City
MANTECA
APN
20604009
ENTERED_DATE
6/28/2019 12:00:00 AM
SITE_LOCATION
13019 CASTLE RD
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /so 1�7 , CITY/ZIPS <br /> CROSS STREET I`Y�✓ICti l C[J�r✓l APN 7,6 PARCEL SIZE'S sd y <br /> 7 � z <br /> OWNER NAME /y PHONE <br /> OWNER ADDRESS v / CITY/STATE/ZIn/�/q/ <br /> CONTRACTOR �Q N V J PHONE nCV / <br /> CONTRACTOR ADDRESS �) / I C�r� �� A�-42 J CITY/STATE/ZIP �Ol l� <br /> /t tl /� //``�� <br /> LICENSE ❑'.. C-42 IIA-36 OTHER NUMBER '7" 37(- V EXPIRATION DATE 20 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION 1 1 ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION <br /> INSTALLATION WILL SERVE: loeRESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES '.2 LENGTH OF LINES h-7C) ft <br /> DISTANCE TO NEAREST WELL /G 0 ft FOUNDATION V ft PROPERTY LINE 5V ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ff LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMIjA119 HOUR ADVANC&NOT1,Ck REQU/RED FOR INSPECTIONS -PLEASE CALL 209 95/3-7697 <br /> SIGNED TITLE Oe7A-� �/C- DATE G- <br /> DEPARTMENT U SE OjV LY <br /> Application Accepted By Date Areamployee ID#�� <br /> Final Inspection By Date ❑ SP CIAL PERMIT-A pproved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS — <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Ry I, Cash Remitted Service Request# <br /> quo s� <br /> 42-01 n ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />
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