SR0081241 - Laserfiche WebLink

Home Browse Search

�. ONSITE WASTEWATER TREATMENT SYSTEM PERMIT .,AN 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 �"��a ��+"" �" '� CITY/ZIP Ly4t,, C� R ). n CROSS STREET Vn APN �V �1O � ©� PARCEL SIZE 2V p'L p OWNER NAME N.,`�� (,-G PHONE toy P b 49 —3-171.-C OWNER ADDRESS (Le�2 C'UV� Lh CITY/STATE/ZIP CONTRACTOR 3e' PHONE '101 d CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑DC-42 ❑I IC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y El PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION LI ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 1 1 DESTRUCTION INSTALLATION WILL SERVE: ESIDENCE 1-1 COMMERCIAL[ i_I OTHER NUMBER OF LIVING UNITS: n f NUMBER OF BEDROOMS: T NUMBER OF EMPLOYEES: EPTIC TANK TYPE/MFG Y' lam- CAPACITY /&UO gal #OF COMPARTMENTS +� ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ® PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) EACH LINES I LEACHING CHAMBERS __ #OF LINES LENGTH OF LINES _S� it DISTANCE TO NEAREST WELL ft FOUNDATION _/LT ft PROPERTY LINE / D 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 ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft fSEEPAGE PITS UMB R WIDTH ft DEPTH 9�� ft DI NCE TO N EST WELL D ft FOUNDATION ft PROPERTY LINE� � ft I HEREBY CERTIF AT AVE PRE RED THI APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, ST LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MIN M 4 H R AD E NOTICE RE UIRED FOR INS/P�EC,TIONS - PLEASE CALL 209 95 -76 7 SIGNED lkz TITLE DATE !� 7 '&/ h N ` -DEPARTMENT USE O VLY / 5 Application Accepted By. Date Area Employee ID# K Final Inspection By Date ❑ SP C L PERMIT-Approved by Character of Soil to Depth of)Ft: Pit1Sump Soil Character: COMMENTS - ,,� IS. -- - - - -- - - -- ----- -- - - --- - -- -- - 1S PE SC Received hec Amount Permit/ Code INFO B Cash emitted Date Service Request# Invoice# Permit ID# 877 08 s s Roo$ l a 4 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18