SR0082172 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFLNDABLE'P/ERMITT AfcjyI jrv-L CALL(209)953-7697 FOR INSPECTIONS /_ EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS .qy q7 % y%gphr� �dQ� CITY/ZIP 4p 4� -i �� w �� 39 $� CROSS STREET APN O O � PARCEL SIZE i +^ Pu I 1p ol3a coOWNER NAME , xa Q �`/ n }� ti OWNER ADDRESS P.a &tx//J`o L�(�/ CITY/STATE/ZIP Cl emert-t 9sa a7 In �/" p/ L��GA PHONE 76q- CONTRACTOR CONTRACTOR ADDRESS /�'7 +�^ , I, (f Q �f CITY/STATE/ZIP S "�" 4� LICENSE ❑ 6-42 ❑IJC-36 OTHER NUMBER /r7�/1' EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: C NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE �s A REPLACEMENT Leech F i tl d I-I OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: �Q RESIDENCE ❑ COMMERCIAL)J PV-- I I C� OTHER NUMBER OF LIVING UNITS: LL NUMBER OF BEDROOMS: ()is c,VLg to NUMBER OF EMPLOYEES: �SEPTIC TANK TYPE/MFG /• nR CAPACITY gal #OF COMPARTMENTS U 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 7 LENGTH OF LINES C� 8� ft DISTANCE TO NEAREST WELL ft FOUNDATION SO ft PROPERTY LINE 600 ,� ft C FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft GP 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 5� WIDTH ' ft DEPTH CPS OF ft Lys DISTANCE TO NEAREST WELL �t ft FOUNDATION /00 � ft PROPERTY LINE �p�0 � 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE��r DATE —l d �O Jq DEPARTMENT U E ONLY Application Accepted Bw_�� Date a a?Jo1O Area Employee ID# DA Final Inspection By Date -W ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: /� Pit/Sump Soil Character: COMMENTS Cxis+ina �ineS raes�+oYeGl W��e r,IJI�G ti Id 0.r �G1lel t1�e►nl�' lnc�lc��s 2 a{,pd��o rtS 5��1 �izeGl r six upG/_r� ,�Iklch .s ,,AaIowners t�ip,��3o�+� beC/ra�j,�rs PE Sc Received heck Amount Date Permit/ Invoice# Permit ID# Code INFO By ash Remitted Service Request# VA o 11.5- l9q, 2 I 300tO ID Ul S2 QD�a 13-2- 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18