SR0080431 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 91I53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �s 1 (Za f_-�r'_-C_ (—A —CITY/ZIP Ere-inch U. "A CROSS STREET 1hgt-CIAI� APN l�O ' /Z PARCEL SIZE p OWNER NAME F'rfrV-lh (_a.Mj? r/�(UQerlil1`9 PHONE d•CJ 1-9�L - ( ( (4 OWNER ADDRESS P. v ( T CITY/STATE/ZIP CONTRACTOR Env',I ry h~kr I y I^L . PHONE CONTRACTOR ADDRESS 44fjpo S I A W V T1 (rp^'-4,%e_ f f/1 CITY/STATE/ZIP U G 1� CA . c 5 L 1 S LICENSE I IC-42 I I C-36 OTHER , UMBER EXPIRATION DATE 3 13 1 A 1 WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y 1 : PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIV REPLACEMENT i OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: 1 ) RESIDENCE L COMMERCIAL I 1 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES i LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUMASWOUR 1.AD NCE FICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE CO'T o ulro DATE 41 F��I 9 l T S N T DEPARTMENT LkSEIONLY Application Accepted Date Area1_tf Employee ID# Final Inspection By Date Fl SPEPERMIT Approved by Character of Soil tooDDepth of 3 Ft: Pit/Sump Soil Character: COMMENTS eSf YQ PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B Cash Remitted I Service Request# o M 8 q/oc) l N, 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17