My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SR0083024
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
D
>
DOVE
>
26321
>
4200/4300 - Liquid Waste/Water Well Permits
>
SR0083024
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/4/2021 1:12:26 PM
Creation date
3/4/2021 12:22:57 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0083024
PE
4211
STREET_NUMBER
26321
Direction
E
STREET_NAME
DOVE
STREET_TYPE
RD
City
ESCALON
Zip
95320
APN
20720032
ENTERED_DATE
12/16/2020 12:00:00 AM
SITE_LOCATION
26321 E DOVE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
3
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
r � <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS! EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> -31/ e� �1CITTY//.ZIP `l`Ci <br /> CROSS STREET APN,7clj PARCEL SIZE it'd <br /> OWNER NAME ' /1�Jz PHONE j✓ > U <br /> OWNER ADDRESS ��� � y2 Yyr�+e� CITY/STATE/ZIP � �� .64 J <br /> CONTRACTOR � � PHONE <br /> CONTRACTOR ADDRESS CITYISTATE/ZIP <br /> LICENSE [IF-C-42 111IC-36 OTHER NUMBER EXPIRATION DATE <br /> 4 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # ' BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: �C NEW INSTALLATION REPAIR/ADDITION I_l ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM u DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY O 0 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> UK LEACH LINES LEACHING CHAMBERS #OF LINES�— LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL 100 ft FOUNDATION V ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATIQN ft PROPERTY LINE ft <br /> l � <br /> SEEPAGE PITS NUMBER WIDTH 2 ft DEPTH ft�-^- <br /> DISTANCE TO NEAREST WELL13 ft FOUNDATION Ito PROPERTY LINE J ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HQN0961E REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-769/7 <br /> SIGN TITLE DATE <br /> J <br /> R &AU <br /> P <br /> EPARTMENT USE O ILY <br /> Application Accepted By Date2� Area ` Employee ID# G <br /> Final Inspection By I Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth oft: Pit/Sump Soil Character: n <br /> COMMENTS <br /> 1 PE SC Received otheck#0 Amount Permit/Code INFO B Remitted Date Service Request# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/13 <br />
The URL can be used to link to this page
Your browser does not support the video tag.