SR0081335 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUW(!OUNTY ENVIRONMENTAL HEALTH DEPARTMENT '1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE kSSUED JOB ADDRESS C4" y ;/� CITY/ZIP / ` CROSS STREET �(SAPN �v, Z �U b 2_ PARCEL SIZE i OWNER NAME �►�"/^j] -2— PHONE v, OWNER ADDRESS ��.. ____ CI-rY/STATE/ZIP CONTRACTOR_ � � at C d Sem PHONE CONTRACTOR ADDRESS 7� /yt/1/. Gti.J�/'- u CITYISTATE/ZIP LICENSE ❑CIC-42 00C-36 OTHER l`j NUN ;7 IBEJ� ',Q_EXPIRATION DATEOF WATER TABLE DEPTH: l — ft GEOGRAPHICAL INFORMATION: Coordinates X Y 0 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: I] NEW INSTALLATION (I. REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM I..) DESTRUCTION INSTALLATION WILL SERVE: A RESIDENCE El COMMERCIAL EI OTHER NUMBER OF LIVING UNITS: / NUMBER OF BEDROOIVIS-.. NUMBER OF EMPLOYEES: t$ SEPTIC TANK TYPE/MFG Z CAPACITY gal #OF COMPARTMENTS 2 0 GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL�yJ ft FOUNDATION �'� ft PROPERTY LINE Yr2 it El LIFT STATION SIZE TYPE OF PUMP 13 PKG TX PLANT Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) 0 LEACH LINES 19 LEACHING CHAMBERS J^C A.JDA^� #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft * FILTER.BED WIDTH /3 ft LLNGTH g�-�� ft DEPTH ft DISTANCE TO NEAREST WELL /"'aO 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_ It * DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM ffj HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CAL (209)953-7697 SIGNED /L--�TITLE ��'ll�-rRT DATE PARTME T OSE aN.LY Application Accepted By Date Area Employee ID# Final Inspection By Date L ❑ SPECIAL�°ERNIIT-Approved by Character of Soil to Depd,of 3 Ft: Pit/Sump Soil Character: COMMENTS PE — SC Received Check#1 Amount Permit/ Code INFO B Remitted D//ate Service Request#/ Invoice# Permit iD# — �V'GO'�� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118