SR0081172 - Laserfiche WebLink

Home Browse Search

e ,rt 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)953-7697 FOR INSPECTIONS AXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �Q� A1J(J/ CITY/ZIP S72- CROSS 7ZCROSS STREET D _ APN O(J��0 / ( PARCEL SIZES OWNER NAME PHONE3/� OWNER ADDRESS c/L� J� CITY/STATE/ZIP c/� / / CA CONTRACTOR 1C�R S{�p�',( m SZ�.J t/" PHONE �? 5-- Lf' -? CONTRACTOR ADDRESS /q-t--j V:'Lh) d'- CITY/STATE/ZIP�J J C 4- /j45.1 LICENSE ❑DC-42 ❑DC-36 OTHER NUMBER EXPIRATION DATE i/ / i 5 WATER TABLE DEPTH: OI ft GEOGRAPHICAL INFORMATION: Coordinates X 7 Y ❑ PERC TEST # BUILDING PERMIT LAND USE APPLICATION# TYPE OF WORK: 0 NEW INSTALLATION 9t, REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE I..1 REPLACEMENT El OUT-OF-SERVICE SEPTIC SYSTEM I J DESTRUCTION INSTALLATION WILL SERVE: 9 RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS _ U GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft 0 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) AM LEACH LINES 'J LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL _ ft FOUNDATION /(�' ft PROPERTY LINE —5 ft FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ® MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft CB SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft CI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ® SEEPAGE PITS NUMBER WIDTH Y ft DEPTH 2 Jr ft DISTANCE TO NEAREST WELL ft FOUNDATION /t7 ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICA O AND THE ORK WILL BE DONE TN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE DATE Itp SAN J q _ IR N E TA. NT -D PAR TM ENT SE N L Y �J Application Accepted By Date / ( Area Employee ID#-�4 I Final Inspection By Date 1 16 ❑ SPECIAL PERMIT-Approved by Character of Soil to D In of Pit/Sump Soil Character: COMMENTS -- PE SC Received Check#/ Amount Permit/ Code INFO B Cash Remitted Date Service Re Uest# Invoice# Permit ID# C) .0 l 5 5a J 177 a 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18