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SU0009141 SSCRPT
EnvironmentalHealth
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SU0009141 SSCRPT
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Entry Properties
Last modified
5/7/2020 11:33:52 AM
Creation date
9/9/2019 10:56:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSCRPT
RECORD_ID
SU0009141
PE
2622
FACILITY_NAME
PA-1200049
STREET_NUMBER
5772
Direction
S
STREET_NAME
VAN ALLEN
STREET_TYPE
RD
City
STOCKTON
APN
18335011 12
ENTERED_DATE
4/6/2012 12:00:00 AM
SITE_LOCATION
5772 S VAN ALLEN RD
RECEIVED_DATE
4/6/2012 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\V\VAN ALLEN\5772\PA-1200049\SU0009141\SSCR RPT.PDF
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EHD - Public
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r <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />$AN JOAQUIN COIIMY ENVIRONMENTAL HEALTH DEPARTMENT JW I, WESER AVE -3' FL. STOCNTON CA 95202-(209) afBJATO <br />Jos ADDR[SS �S%�o� C �ifytl izx1Pal VLi Cm12D• !'6 <br />CR095 STREET A24{��� �(q� - APN / 3STi' Q� PARCELSDl0 <br />OWNER NAME T` "'OW + KYN+'1( ✓� PRONE <br />OWNER ADDRL[5 CDT/STATMIP <br />3,� CZR r ,( v\ Cn r I i-,( „ PH F. 17%AG -a�oq I <br />CONTMCTORADDRCEE CITY/STATi21P <br />LICENSE 0C<2 ❑C-16 OmFa NUMBER EXPIRE, <br />WATER TABLE DEFTH: fl GEOGRAPHICALINFORMATION: COOTEina1A % Y <br />❑ PERCTEST N I I BUILDING PERMIT IS LAND USE APPLICATION <br />❑ REPLACEM�pEON-.T'' <br />INSTALLATION WILL SERVE: Pr. <br />Ll DmxwTT. <br />❑ COMMERRAL T <br />NL <br />SEPTICTANK <br />TYPUMM CVC <br />CAPACITY JPK-NL> <br />SRI <br />NOFCOMPARTMENis�_� <br />T�Z IT1f)� ft <br />❑ <br />GREASE TRAP <br />TYPEIMFO <br />CAPADITY <br />Nal <br />NOFCOMYAETMENTS <br />DISTANCETONEARLST WELL ft FOUNDATION fl PROPERTY LME <br />❑ <br />PKG TX PLANT <br />DISTAMCLTONGRERT: WELL <br />ft FOUNDATION <br />ft <br />Pac ERTYLME ft <br />❑ <br />LIFT STATION <br />STEE TYPEOPPOMP <br />❑ SAND OIL SEPARATOR (ENCI.DEEDSYBTERI) <br />W'.. R IENOTH fl DEPTH <br />NL <br />LEACH LINES <br />❑ LEACHING CHAMBERS NOFLMES_�LFS LENOTHOFLw" R <br />DISFANCETONEAREST WFLL R FOUNDATION aft PROPERTY LINE <br />T�Z IT1f)� ft <br />❑ <br />FILTER RED <br />WIM H LEHOTlI ft DEPTH <br />R <br />DISTANCETONEARLST WELL ft FOUNDATION fl PROPERTY LME <br />R <br />❑ <br />MOUNDED <br />WIOTN R LENGTH ft DEPTH <br />ft <br />e.T <br />DI51'AfMFTO NEAREST wELL B FOUNDATION _ fl PROPERTY LME <br />It <br />❑ <br />SUMPS <br />W'.. R IENOTH fl DEPTH <br />ft <br />DnTANCETONEAREST WELL__ft FOUNDATION ft PROPERTY LME <br />ft <br />❑ <br />DISPOSAL PONDS <br />WRTTN ft LENGTFI_ R DEPTU <br />ft <br />Rrr <br />DISTANCETONEARnEr WELL ft FOUNDATION ft PROPERTY LINT <br />ft <br />Tl <br />SEEPAGE IRS <br />NliMeeR -WRYm - ft DEPTH a.S <br />R <br />DIRTANCETONWREST WEIf, IlL'I R FOUNDATION "70 ft PROPERTY LME <br />421N.I-P It <br />1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND VIE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORM NANCM, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />JDRiJDI ONSITE WASTEWATERPERMIT <br />I1IJ}TJpM <br />
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