SR0082243 - 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 209953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM MMJDATE ISSUED JOB ADDRESS H S� J Ab 11/`J l (-4V 6 CITY/ZIP Sfb L1-� `� C I Z CROSS STREET - t V 1 Ie Me,`1e, 1 APN 0 O� L) J� PARCEL SIZE - a 3 0 OWNER NAME G Cw t o N, PHONE ^� OWNER ADDRESS A� -sy b CITY/STATE/ZIP ` �Ij CONTRACTOR V v��M l�ll� l.f/U�i—� L 1�/ PHONE 2cq v-39 1 M 4 33 i'Y1"%1 11 5�-. LodA , CA C15240 CONTRACTOR ADDRESS Q CITY/STATE/ZIP LICENSE 1_11 IC-42 I I I IC-36 OTHER A NUMBERS511,51 EXPIRATION DATE w2-3 WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: I NEW INSTALLATION ,f- REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: )t. RESIDENCE i_I COMMERCIAL 1 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 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) ❑ LEACH LINES ,,LEACHING CHAMBERS t 1 ' 1 111 1i(S #OF LINES LENGTH OF LINES Z- ft DISTANCE TO NEAREST WELL �y It FOUNDATION IOC ft PROPERTY LINE )c)i 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 it PROPERTY LINE ft ❑ SUMPS WIDTH It 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 SEEPAGE PITS NUMBER Z WIDTH 3(0 ft DEPTH 25 ft ✓✓✓��\ DISTANCE TO NEAREST WELLf-jjjq� ft FOUNDATION tQ+- —ft PROPERTY LINE It I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUMA8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEA-S-Et—CA,LL 209 953-7697 SIGNED TITLE �C13`( DATE 0LA W 1 I Z-1 DEPARTMENTUS ONLY Application Accepted B L� DateDvZO Area Employee IDP I / I - - 'W"CIU Final Inspection B Date to I �Zy ❑ SPECIAL PERMIT-Approved Y rr� Character of Soil to Dept o 3 Ft: PIVSump Soil Character: l2 tic:nG�vb1}c v�rn[er e �< rn��kI?F f1ec+ ID, (�!w-2 3 !' "w— COMMENTSl 2 SAN 7 Q ENVIRO /N .OssUN' PE SC Received hec Amount Date Permit/ Invoice# Permlt rwryT Code INFO B ash Remitted Service Request# -47141% 0 35,xx bzz y 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17