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SR0081095
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4200/4300 - Liquid Waste/Water Well Permits
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SR0081095
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Last modified
9/19/2019 7:47:35 PM
Creation date
9/13/2019 9:53:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0081095
PE
4222
FACILITY_NAME
12470 E LOCKE RD
STREET_NUMBER
12470
Direction
E
STREET_NAME
LOCKE
STREET_TYPE
RD
City
LOCKEFORD
Zip
95237
APN
05132012
ENTERED_DATE
8/29/2019 12:00:00 AM
SITE_LOCATION
12470 E LOCKE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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TSok
Tags
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 /> Joe ADDRESS 12470 E Locke Road CITy/ZIP Lockeford,95237 <br /> q <br /> CROSS STREET Fillmore Street APN 051-320-12OW PARCEL SIZE 23.61 0 <br /> 0 <br /> OWNER NAME NRC Equity Fund 1 PHONE 707 235-5542 <br /> OWNER ADDRESS 736 S Center Sl. CITYISTATE/ZIP Reno,NV,89501 <br /> CONTRACTOR Advanced GeoEnvironmental,Inc.(AGE) PHONE(800)511-9300 <br /> CONTRACTOR ADDRESS 837 N Shaw Road CITY/STATE/ZIP Stockton,CA,95215 <br /> LICENSE [I C42 1_1 C-36 OTHER C-57/A-Haz NUMBER 680227 EXPIRATION DATE 11/30/19 <br /> WATER TABLE DEPTH:-125 It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> RI PERC TEST #1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION _. REPAIRIADDIT10N ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: L RESIDENCE L COMMERCIAL Ll 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 It FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP Ll PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTERBED WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE IYI� <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH A-�r <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE <br /> ❑ SUMPS WIDTH It LENGTH It DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It v O <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �O,O <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH AL <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCE ,,qR Td i'r•/ <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MFHT <br /> REQUIRED FOR IT <br /> SIGNED TITLE Senior Geologist DATE 29 August 2019 <br /> EP'ARTMEN E OAILYr— or <br /> Application Accepted yDate Area 01/ Employee ID#—S <br /> Final Inspection By Date 42f/ zwr L7 S11 P L P M -Approved by <br /> Character of SoiltJ�Depth of 3 Ft: _T P <br /> it/Sump Soil Charraacter: <br /> COMMENTS <br /> PE SC Received Chec AmountDate Peffn Invoice# Permit ID# <br /> Code INFO Remitted Service Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />
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