SR0082397 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1866 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 NON-REFUNDABLE PERMIT CALL 209 953-7697FORINSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS I( d 0 0 KE 7'7-t.6 MA /V L eJ . CITY/ZIP L-D D I Rr 2-It 0 / t y CROSS STREET (� �• ay APN 0(-v3- I xo-1 0 PARCEL SIZE S 17 p _ O OWNERNAME S�KF'fm lNnCtrL SI�u IJH ►'1'1 Al°1'�J PHONE `"(a- -7`Fo OWNER ADDRESS SkVN IE CITY/STATE/ZIP CONTRACTOR (-1 t/-t O d"M CTEO eNV0LONYh Ew AL- PHONE 3(PI 031 5;- CONTRACTOR CONTRACTOR ADDRESS 940 1 w' OlYK S-I-• CITY/STATE/ZIP LOD t (,'A 'q T 1 1.) LICENSE E L C-42 U C-36 OTHER C Ii� NUMBER T(S I EXPIRATION DATE 44-30-7-2- WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST #____L_ BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ,. ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM ,_ DESTRUCTION INSTALLATION WILL SERVE: _ RESIDENCE D COMMERCIAL 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 1. LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ 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 it 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. I E REQUIRED FOR/ 2953-769 SIGNED TITLE P/Z-aJ ►�b 2• DATE -7 �� 1. ANA E YMENT CEIVEO 20 2020 Aou�N c H P-44 all — I'D AL M L DEPARTMENT USE ONLY I' Application Accepted By — - Date 7 J 0;0 Area � Employee ID#� Final Inspection By Date SPECIAL PERMIT-Approved by Character of Soil tf pth of 3 Pit/Sump Soil C racter: COMMENT0. �I'I ISA . S y�2!jlLn�. frJ PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO By CashRemitted Service Request# y3.3 S,)31* 1 ;ISS " 8,13 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 N