SU0013225 - 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 c� EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS CITY/ZIP 1 !4✓t L L, c,N1 3( L CROSS STREET 14I r I.O(- T w� APN �o (0 PARCEL SIZE OWNER NAME Irl f� �.� 1 PHONE r OWNER ADDRESS L µ,I.� 04 1 CITY/STATE/ZIP �lert G7ln �4N't�{� �l i/ /1SZ3I CONTRACTOR_Nell D, 14ALI SeI aao�tb50CI 14e r/Ttr"L CON CO. PHONE �Z��I� J�/� ✓ �OGI 7 CONTRACTOR ADDRESS d1G Z LriILa5+1---4 I tja-I O LICENSE ', C-42 C-36 OTHER / CITY/STATEJZIP � • �T�(„ (- NUMBER S-7 G O EXPIRATION DATE l3! 1 WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y / `_� PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# IIIA— 3 O )n6 TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: U RESIDENCE I I COMMERCIAL I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS DISTANCE To NEAREST: WELL It FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES __A DISTANCE TO NEAREST WELL ft FOUNDATION A PROPERTY LINE II ❑ FILTER BED WIDTH ft LENGTH It DEPTH fl DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE fl ❑ MOUNDED WIDTH It LENGTH _ It DEPTH fl DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE If ❑ SUMPS WIDTH If LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH It LENGTH fl DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH fl DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE WS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIM 4 HO�kXaVANeE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-76 7 SIGNED TITLE SYS - e G DATE Z ( C-lvNT En 2 4 2015 UIN HUI MEI�T�UNr1' -- FPgArMENT DEPARTMENTUSE OWL Application Accepted ByDate - `- Area 1 � Employee IDN Final Inspection By ��! Date -37/Aa — I SPECIAL PERMIT-Approved by Character of Soil to De th of 3 Ft: PIU ump Soil Character: COPnIENTS l/1 PE SC Received Che Amount Date Permit/ Invoice# Permit ID# Code INFO B ash Remitted Service Request# 22 I -3 1 -7- 42-D1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 424 12