SR0082191 SSNL - Laserfiche WebLink

Home Browse Search

/Oq-19 ONSITE. WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3"FL-STOCKTON CA 95202 - (209)469-M28 r NON-REFUNDABLE PERMIT ,,t CALL(209)9 7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOBADDRESS 14V F�r(�T� > CITY/ZTP _ LA CROSS STREET - �• y�S APSJV2 �__7 PARCEL SIZE I :79� Q OWNER NAME T .y r-�' t�� PAHO/NE��-}�/� � r/� rn OWNER ADDRESS 'I. t�F 'IR-J CITWSTATEIZIPSC�VIL-d U -- ' 5G-�L5 y CONTRACTOR -A 4-11 S l r t" )19-1 •��.__._._....___...____ PHONE CONTRACTOR ADDRESS _ CITY/STATEIZIP LICENSE ,C-42 ❑C-36 OTHE 1 NUMBER L EXPIRATION DATE WATER TABLE-DEPTH; ft GEOGRAPHICAL INFORMATION: Coordinates X y ❑ PERC TEST ti — $UILDING PERMIT LAND USE APPLICATION ll TYPE OF WORK; NEW INSTALLATION ❑ REPAIR/ADDITTON ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS:_ NuMHER OF BEDROOMS: 4- NUMBER OF EMPLOYEES: F SEPTIC TANK TYPE/MFG{ i CAPACITY gal ii OF COMPARTMENT$ ❑ CREASE TRAP TYPF/MFG— _ CAPACITY �� - 3�`� W gal #OF COMPARTMENTS�J/�� ❑ PKG TX PLANT DISTANCE 70 NEAREST: WELLI�� f[ FOUNDATION' R PROPMTY LINE ❑ LIFT STATION SIZE _ TYPE OF PUMP __ ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS F 56 L #OF LINES LENGTH OF LINES ft DISTANCE TIO NEAREST WELL_ % ft FOUNDATIONO ft PROPERTY LINE_ � `, (t ❑ FILTER BED WIDTH __ ft LENGTH_ �ft DEPTiI ft —--" DISTANCE TO NEAREST WELL..,_ R FOUNDATION fi PROPERTY UNE ft -Iv .lp, C3MOUNDED WIDTx___._..._..............__ ft LENGTH t2 DEPTH ft V DISTANCE.TO NEAREST WELL__ fl FOUNDATION...._ _ _ _ T it PROPERTY LINE ft , SUMPS WIDTH _—__P. LENGTH R DEPTH _ g DISTANCE TO NEAREST WELL___ft FOUNDATION fl PROPERTY LINE � ft O DISPOSAL PONDS WIDTH It LENOTH ft DEPTH ft DISTANCE TO NEA R, WELL ftFOUNDA7KIN ft PROPERTY LINE ft 3Y SEEPAGE PITS NUMBER WmT�y� DEPTH ft DISTANCE TO NEAREST WELL _ -!2 F)UNOATION "I fl PROPERTY LME _ ft (, 1 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. C' �lMNOTICEREQUIREDFORIN I-P EASECALL(209)953-7697 SIGNEN6.1 Vx3l —_ TI- DATE ( Fq IV t I� a 0 ' NIR N E r H L H EP NT I II-AT.111 1 ID DEPARTMENT US ON y Application A¢eept2d Date -y/'�J_ Area �-�� Employee 1114 Final Inspection B Date fA/ ❑ SPECIAL PERMIT-Approved by (/ Character of Sull to De h of 311,.- ... Ft: Pit/Sump Soil Character: COMMENTS jcJ ( j- c recv:-d 13rD—/cir)2 S=,Q PE SC Received Choc Amount Code INFO Permit/ Invoice# Permit 1Dq B ash Remitted Date Service Request p ll7 S2C.ZrJ ~ CIC J i 42-02-00I 12222003 ONSITE.WASTEWATER PERMIT