SR0081290 - Laserfiche WebLink

Home Browse Search

A 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 1\0 �h. ' l< 9) CITY/ZIP j4A 4 ktcti �, 9dri �7!i,3 CROSS STREET ( ( ;Y APN ` ( 1 PARCEL SIZE OWNERNAME / l I" 1LC��IIACiL6l �Y�'�rC•�" eAc, PHONE j OWNER ADDRESS / `� ENCS �L-3 CITY/STATE/ZIP P_nr�'S j n]5 of- 7 :7v 1 C CONTRACTOR l�{1 �.tl� lGj�ISI Gf/PPi [' PHONE CONTRACTOR ADDRESS IC'l' �l 7\ CITY/STATE/ZIP LICENSE ❑I iC-42 [IDC-36 OTHER » NUMBER 'L{ EXPIRATION DATE �� 1p� WATER TABLE DEPTH:(/V ' "/ D ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: G NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE I I REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE IJ COMMERCIAL IJ 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 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 01 LEACH LINES LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES Jt ft DISTANCE TO NEAREST WELDft FOUNDATION ft PROPERTY LINE 14)1 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 gylle�.. ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEfft E3 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH _ rCl�It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEUC t_ ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH SAN `v! ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY 1 1 - MQ Cn ft Cr -' Eiy ' I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. NT MINIMUM 4 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE�)4 r /�C e. C/7— DATE EPARTMENT SE N Y Application Accepted By Date Area Employee ID# Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: COMMENTS ��, PE Sc ReceivedChash Amount Date Permit/ Invoice# Permit ID# Code INFO B Remitted Service Request# o 18EA is.zuL c0,&2- 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18