SR0082316 - 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 EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 33S AJ• PA-I"fa rJ AVE. CITY/ZIP S?Ty C IGTatV R S' Z 1 S CROSS STREET Abpr ?we• APN 163 - !36 -3 1 PARCEL SIZE 2•Z AC' C OWNER NAME ��l t�R'7 IrlTV PHONE OWNER ADDRESS 102- N 0-rn AJ&ttYVyv\ 1>f2. CITY/STATE/ZIP -7�� CONTRACTOR LIVE U A'lL �sCQE�/IK ON�G►�/1 �•� PHONE ��I �0 3 /1 l CONTRACTOR ADDRESS &J,3-7&J,3-7W W. O'er ST . CITY/STATE/ZIP �-0151 C 10r VfJ-11.40 LICENSE E'.:C-42 ❑iX36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: .. NEW INSTALLATION .... REPAIR/ADDITION I_i ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL L 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) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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. MINIMUM E NOTICE R D F -PLEASE CALL(209)9517 SIGNED TITLE PAVJY19bR DATE -7-10 -LO F YMENT CF jV�D AIL 10 Z020 D E P A R T M E N 7 ItSE ONLYlyV/R�UIIyCpU Application Accepted By -.;E �—L� Date' D J:C� Area Employee ID# �P FNTgt Ty Final Inspection By R1" Date aVri.W D SPECIAL PERMIT-Approved by ARTM�Nr Character of Soil to th of 3 Ft: Pi ump S it Ch Iter: COMMENTS �L �Q 22.� ✓ylih /M PE SC Received he #/ Amount Date Permit/ Invoice# Permit ID# Code INFO By as Remitted Service Request# 1110 0 , 2�1 29222119 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18