SU0003948 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEVI TER TREATMENT SYSTEM ' "IRMIT SAN JOAQUIN COUNTY ENVIRONMENTAL.HEALTH DEPART�1T I' 304 E WEBER AVE -3`,,. -STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS P C eCITY/ZIP lM 0 >� /�/� yy�/j D CROSS STREET C- 1 (2o APN 00 z 70 - ;, 1-7 PARCEL SIZE Sl1 n p PHONE a OWNER NAME - •,,(( I /� K OWNER ADDRESS -` �[�(. `aVF CITY/STATE/ZIP ze)d( CONTRAC-l'OR � f'�►Y.CCI (�r e�o)� q� �' r` ` PHONE ! - >370J�) CONTRACTOR ADDRESS f'c�U�J C✓� L-UC�f fr f-i CITY/STATE:/'ZIP LICENSE ❑C-42 ❑C-36 011ILR NUMBER _ I.XPIRATION DATE: WATER TABLE DEPTH: tl GEOGRAPHICAL INFORMATION: Coordinates X _ Y PERC TEST(S) NUMBER i LAND USE APPLICAIION# ILI A /(J TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/A ERNATIVE ❑ REPLACEMENT ❑ DESI'RUCIION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG CAPACITY___ _ gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY----------- gal #OF C PAOMENTS L) PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION _ OP TY E fl ❑ LIFT STATION SIZE TYPE OF PUMP ❑ S#9101 SE OR(EN LOSER SYSTEM) ' n ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINFS LENGTH OF LINES DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH Il DEPTH ft DISTANCE TO NEAREST WELL tl FOUNDATION It PROPERTY LINE fl ❑ MOUNDED WIDTH fl LENGTH _ fl DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION_ Il PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH fl DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ti ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL fl FOUNDATION_ ft PROPERTY LINE (I ❑ SEEPAGE PITS WIDTH 11 LENGTH Il DEPTH ti DISTANCE TO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE fl 1 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. �I�NINIUNI�24HOUR ADVANCE NOTICE:REQUIRED FOR INSPECTIONS-'j�PLEASE CALL(209)953-7697 / �{ SIGNED0� TITLE & lJ_ DATE •` J - -- e .fr ,00 .171799 170 t qj We Vi .QI � '�-• .9f'Gl9 � � to .� u -„�_• 0_ N I N In N i t ? ✓+/ �' D1 f j T a 1 J o C p 1. O 2 Yq 4V %p ^ y ,T J U + y ,fC'C99 LL .::.JtS9 ;N ,IO .gJ h ,(t'11.9 m ”' .t0'99f BO l6► I" W o . C'kt o _ fa st q 4 �y 8 (, In y ittt 4E VIR N E TA DEPARTMENT ll' O ' Y RTMENT Application Accepted By !2 ate O Arca Employee ID# Final Inspection By ?ytezzr� Date i42 �5 ❑ SPECIAL PERMIT-Approved by / Character of Soil to Depth of 3 Ft: Pit/Sump Soil C racler: COMMENTS i� 2 PE Sc Received heck#/ Amount Permit/ Dae tit o'ce# Per Code INFO By as Remitted Service CRequest# - 42-01.001 1212102 ..-3f, -; 3;-- `�_3? �,�a.C�T ONSITE WASTEWATER PERMIT