SR0080441 - 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 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED ♦JOB ADDRESS CITY/ZIP • ,4 27y CROSS STREET O APN TZy 1:/O /� PARCEL SIZE CJ v 7y OWNER NAMEL ` O PHONE CA OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR �/ C PHONE s,/y� CONTRACTOR ADDRESS � /a�( � , c�J d,- CITY/STATE/ZIP LICENSE LI. IC-42 CII IC-36 OTHER NUMBER�I`sy� EXPIRATION DATE WATER TABLE DEPTH: U+VGE RAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: s NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: R RESIDENCE I I COMMERCIAL � I OTHER NUMBER OF LIVING UNITS: (1 / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: IN SEPTIC TANK TYPE/MFG A C� ��/�L� CAPACITY �V gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL - ` ft FOUNDATION 5"'o ' ft PROPERTY LINE ft LIFT STATION SIZE TYPE-OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES OF LEACHING CHAMBERS J�4�� t #OF LINES / LENGTH OF LINES ft DISTANCE TO NEAREST WELL 4-143 ft FOUNDATION / ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH E- ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE .J ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH '4 ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPER P40A ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH IoZRONMcOft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN_ NE DEPAW;Ala, 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. MINIMUM 48 HOURADVANCE NOTICE REQUIRED FOR INSPECTIO S-PLEASE CALL 209 953-7697 c SIGNED TITLE �Gk� �` DATE jza r� :_w Z •JhTMA SE LY Application Accepted ay , Area Employee ID# Final Inspection By Date LI SPECIAL PERMIT-Approved by Character of Soil to epth of 3 Ft: PIU u p Soil Character: COMMENTS i 1 ' SK PE SC Received hec Amount Permit/Code INFO B as emit d F.NgDate rvice Request# Invoice# Permit ID# 4 '::�!�;7T *0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17