SR0082689 - 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 11000 N• JDn1A-r-HJ NJ C` • CITY/ZIP $7D C-l-TarJ 992-12,- y CROSS STREET APN Vy t 5 �a 0 0� PARCEL SIZE 1• 7 7 0 OWNER NAME j5IZnlf S T t-ft LCrvIJV PHONE Z5 k- 3JU3 OWNER ADDRESS P•O• 30 I '�Z �—a moi. CITY/STATE/ZIP �,t5-m�`VrJ C • r T`� / CONTRACTOR LI V E��Dtt A<IL &Cot_7V✓Irevr+M E'7 /r-1 L PHONE API-d37 S p �� CONTRACTOR ADDRESS TO l w• S-T• CITY/STATE/ZIP Low LA LICENSE `.' C42 11I.'.0-36 OTHER �'t NUMBER 2-15-1 EXPIRATION DATE >0 2-Z WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y )( PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: L! RESIDENCE COMMERCIAL F 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 It FOUNDATION It PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 49 HOIX ADVANCE NOTICE RE IR D FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE P)r-O J• riot 64-'-• DATE O ou VNT 2020 Q O UN TAt / DEPARTMENT USE ONLY ( FNT Application Accepted �� p', - Data 40 f Area l 9� Employee ID# DA Final Inspection By ' Date 1y ' T 1 u O '-1 SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: �` Pit/Sump Soil Character: COMMENTS PE SC Received Check# Amount DatePermit/ Invoice# Permit ID# Code INFO By as Remitted Service Request# '1332 sa3 4-Is 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18