Laserfiche WebLink
LBUILDING PERMIT It LAND USE APPLICATIOpAyMENT <br />ENGINE erhyttrATIVE <br />DESTR <br />] PERC TEST a <br />TYPE OF WORK: NEW INSTALLATION REPAIR/Morgue <br />REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM <br />REQUIRED FOR I <br />TITLE <br />H R <br />SIGNED <br />Employee ID# <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN 4JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205- (209) 468-3420 <br />NON-REFUNDA IT __4ALL (209)953-7697 FOR INSPECTIONS EXPIRES YEAR FROM DATE ISSUED <br />JOB ADDRESS _ . afiT__ boilin- (200 .arazie <br />CROSS STREETo?i,a___BA:Mhbe_f___AtifilD APN an-02C - 170 PARCEL SIZE I .0(3 <br />OWNER NAME raaf-Aa.., _A_____ , Limo& L viurett.L. Tn-- p.E9,16-5Z5_liti <br />OWNER ADDRESS tt5____W. WAL-),ArS 3 Cm/STATE/2w c1 Lo 52A-0 <br />CONTRAcTOR DA. P tit 1 . 't (-0 Ca,. I. PHONE 466-)6(57 <br />CONTRACTOR ADDRESS 40,a) -NI—WI 411 1.°J IP I WY/STATE/2m S N 9205 <br />LICENSE Y C-42 {.L C-36e_OTHEA _A NUMBER 106 ll_ EXPIRATION DATEA II__ <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATiON: Coordinates X <br /> <br />1..] COMMERCIAL ,, OTHER <br />NUMBER OF LIVING UNITS: ____ .____ NUMBER OF BEDROOMS: ..._. NUMBER OF EMPLOYEES: <br />7 SAN JOAQUIN COUNTY <br />SEPTIC TANK TYPE/MEG 511511_ I.—I & CAPACITY Sal ft OF PNVIPitAMEMTAL.---- <br />LI GREASE TRAP TYPE/MFG CAPACITY gal 4 45kNXTINPARART3M.ENT <br />INSTALLATION WILL SERVE: RESIDENCE <br />DISTANCE TO NEAREST: WELL it FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP Q PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />60 ft LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL... <br />FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL__ ft <br />MOUNDED WIDTH ft LENGTH <br />OF LINES I LENGTH OF LINES <br />ft FOUNDATION 3 0 ft PROPERTY LINE 5 ft <br /> ft DEPTH ft <br />FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />DISTANCE TO NEAREST A WELL _ __ . ft FOUNDATION __ ft PROPERTY LINE ft "T— <br />il SUMPS WIDTH 'Lt._ ft LEN1- DEPTH ft <br /> ft DISTANCE TO NEAREST WELL ft .1 FOUNDATION ..... PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE <br />HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPEN410N LAWS. :SS:41100V H.L1S - PLEASE CALL (21)9)953-7497 <br />3 LI DATE <br />.1 J... ..1 <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to De h of 3 t: <br />COMMENTS <br />PARTMENr <br />Date ..,.q Area <br />6e-eDat e .1 /2-Z1 SPECIAL PERMIT - Approved by <br />crci Op Soil Character: <br />PE <br />,Cede <br />SC <br />INFO <br />Received <br />B <br />Checka/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request Of Invoice * Permit IDS <br />4tX <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17