SR0081695 - Laserfiche WebLink

Home Browse Search

` ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)465-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS kC(D-i6 A) JACk TO-JF- Y'Zy CITY/ZIP I-iJ i ��KD CROSS STREET S o2h6htT RD APN C/�J �(J'�"�- / PARCEL SIZE Q OWNER NAME QUgV,—: 1/4�' ',RV ![��HtS1' - PHONE OWNER ADDRESS �Tl�ll� CITY/STATE/ZIP CONTRACTOR J5 CO US«��C�Lb �' SEDC - __ _ PHONE -(�Q-L2 G CONTRACTOR ADDRESS � �7 /t!C!' �`Sv� - F'L� I Z J_' Z--,VU CITY/STATE/ZIP 3 x"'24 % 'VO' � I Seoo _-1' LICENSE t/t/42 .. C-36 OTHER - NUMBER 2-VY EXPIRATION DATE_0(�30 7_0z0 WATER TABLE DEPTH: l ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL 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) Ip LEACH LINES V LEACHING CHAMBERS iitF.Vrl f- #OF LINES_2 LENGTH OF LINES YU ft DISTANCE TO NEAREST WELL 70 ft FOUNDATION �S+ ft PROPERTY LINE L 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 Ud SEEPAGE PITS NUMBER WIDTH 0& ft DEPTH 25 , 5 , ft DISTANCE TO NEAREST WELL 100 ft FOUNDATION S ft PROPERTY LINE J 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. MINIM 48 HOUR Al2VAN(2a NOTICE REQUIRED EQa INSEECTIQNS PLEME OLL (21122)253-769 SIGNED �_A5 TITLE Ac"�) zeltn DATE V/-3t - Zczv ENT CE V_ED 2020 IN OUNTY {EAL H N TAL TMENT DE PARTMEN USt ONL Y Application Accepted B -Date Area Employee ID# Final Inspection By Date 2 7,Z7 SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received (OegW Amount Permit/ Code INFO B ash Remitted 1Date>, Service Request#ell Invoice# Permit ID# r.!V V 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18