SR0082499 - 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 nn CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �Q_Tei 41Y ._-_�.,�r _ _ ___ _ _CITY/ZIP�_� ZJ h/ iQ �IL,�}- y CROSS STREET hi_w ,1 11 ._IC_/=V A'PN_)�1 Q l-�_.. PARCEL S�1L�=1-{'' OWNER NAME�ll._C--{--L"L ._L�'_MM�,,��f,,l,,/"'�NV---�1L --- --PNONE _/' I l/�' (/�'E?�C��)� 'n OWNER ADDRESS —_T.e�� ..__CITY/STATEIZIP�� 1i1C 7!JLI CONTR,CTOR v �N v (��■-�I- ^-. PHONE ./�-"!{ CONTRACTOR ADDRESS JSt _ 1�(T T_ CITY/STATF/ZIP 1404.(C y COro'! LICENSE C42 )kC.36 OTHERNUMBER1 ��"l[Ii/t � %PIRA710N DATE � _ WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates XY PERC TEST ! BUILDING PERMIT x LAND USE APPLICATION# TYPE OF WORK: NEW INSTAILAnON REPAIR/AODITION GNED/AL REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM CD, RUCnON INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL I NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS: NUMBER OF EYPLOYECS: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal M OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal M OF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM ❑ LEACH LINES LEACHING CHAMBERS MOF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE LIA /�� FILTER BED. WIDTH ft LENGTH ft DEPTH ft /`� D DISTANCE TO NEAREST WELL h FOUNDATION ft PROPERTY UNE�R' ❑ MOUNDED WIDTH ft LENGTH ft DEPTH 77 /Tf/ 11 24 '7O DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ^1cA/ ._ft 7 ZO E3 SUMPS WIDTH ft LENGTH ft DEPTH —�d� ' DISTANCE TO NEAREST WELL M FOUNDATION ft PROPERTY UNE T� �CO 13 DISPOSAL PONDS WIDTH IN LENGTH ft DEPTH 147,1 r� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft MEHT ❑ SEEPAGE PRS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED TMI$APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. I M M TIREQUIREDF R INSPECTIONS T"111-1 (2021252-7697 SIGNED_ _._ _ r- --- _ _-_ _-- TITLE�W_/r( _ - --- - DATE AIA I I I `—I I Application Accepted B$ U DateI u Area ) �� Employee ID# �f , Final Inspection By /�L CSL `� Date� 1 d C SPECIAL PERMR-Approved by Character of Soil to Depth of 3 Ft: PI ump Soll Character: COMMENTS Co;^f7Pcilri14 7J oL'61 ' eWe)' PE SC Received Check#/ Amount Da<a PsrmtU Invoice I Psrmlt IDI Code INFO gash Remitted ServiceR ! 1�d-, 10 75 1 i I :d 42-01 1123:S-1-21,2— ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 1