SU0003904 - Laserfiche WebLink

Home Browse Search

ONSITE WAV 1 WATER TREATMENT SYS' -IM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH 17PPARTMENT 304 E WEBER)"*-34°FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS Z P 3 r- C G t o TA�5- C/zz=1-iC G CITY/ZIP C- ^-0 5"z z) LA �+ M CROSS STREET /}L L'/LLQ /Z d- APN D d - I t7 ` Z� PARCEL SIZE a U Fc r(+ -- �j F OWNER NAME Y /CI�L1 N41IZ MST S�LI�CIJ PHONE c32-r-�7�V S 7t j& OWNER ADDRESS /'/ 17 ��U x CITYISTAT£1ZIP L-/Fhb^%/J f S"Z'L 7 CONTRACTORhL S Kr A/) 13�4�/C/ Si ��c ` PHONE �1 x s-5fry CONTRACTOR ADor L X CITYISTA /ZIP L r�r/rti G�$ Z I ) _ LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: I l� ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# .—0302-s,U2-LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: &I RESIDENCE ❑ COMMERCIAL ❑ OTHER + NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: I$ SEPTIC TANK TYPE/MFG Q/2EG 4$ r CAPACITY /Z-d gal #OF COMPARTMENTS 2- El ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 0- LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES �/G� ft DISTANCE TO NEAREST WELL _Z U-O ft FOUNDATION IS ft PROPERTY LINE jd O'D ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft t DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft `N ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft e DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft O DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R d SEEPAGE PITS NUMBER 3 WIDTH 3 6" ft DEPTH 2- ft �f DISTANCE TO NEAREST WELL 2-00 ft FOUNDATION $i- ft PROPERTY LINE ft 1 HEREBY CERTIFY THAT 1 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. 11tINIMv 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED / TITLE_ /Jl�titZ DATE At ' DEPARTMENT US ONLY Application Accepted Bye-�—' Date C i t'1 Area �- Employee 1D# Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soli to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS It .0✓cf I-r- o -&aa a-eCd # c f- Lv `' 4 :T-4 La I PE SC fteceivcd Check#/ Amount Date Permltl Invoice# Permit iD# Cade INFO B Cash Remitted Service Request# 2-11 117 3 2-0 .V-L) 5 P-0 0 -3- 1Q� 42-02-001 ONSITE WASTEWATER PERMIT 12/22/2003