SR0083085 - Laserfiche WebLink

Home Browse Search

ONSrrE WASTEWATER TREATMENT SYSTEM PERP\,fiff SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 MON-REFUNDABLE PERMIT CALL(209)953-7697!FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS CITY/ZIP CROSS STREET ' APN 101 a6 036 PARCEL SIZE d• OD C h ` d OWNER NAME'J""""/ V PHONE� ��' OWNER ADDRESS CITY/STATE/ZIP / rN�� CONTRACTOR )� /��( /�J/J�/��{�jfj/J/� C (✓�.G PHONE q?/-/1f Sz CONTRACTOR ADDRESS / 2 �j ryJL� _ —CITY/STATE/ZIP LICENSE ❑LIC-42 ❑UC-36 OTHER NUMBER9!a76YEXPIRATION DATE WATER TABLE DEPTH: I 1 0-00 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE 11 REPLACEMENT 71 OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: Ae RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: /JNUMBER OF BED/ROOMS: �&Z /' NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG 12 /-'C [� .��J/ -CAPACITY /�`� D�/ gal #OF COMPARTMENTS C GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL^ZU 7-X ft FOUNDATION ft PROPERTY LINE > ft 0 LIFT STATION SIZE TYPE OF PUMP L7 PKG TX PLANT ® SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS #OF LINES_ LENGTH OF LINES ft DISTANCE TO NEAREST WELL l ate ft FOUNDATION__/O ft PROPERTY LINE. L ft �i FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C3' MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft U 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 Gam- WIDTH 9/eG ,, ft DEPTH 9"5- DISTANCE � ft 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. MINIMOA 48 HOUR V A E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE � � DATE Z pal e �:2D oo 76 o v rr IllNT ED 020 OWN-COUNTY IR N E TAL AV rM MENT 31 DEPARTMENT USE ONLI' Application Accepted By _ Date M dgdox Area qC1 Employee ID#� Final Inspection By Date' �� Z� ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS /JeW SFR. 7:1,Fr -1� . /jc ,J816 W)411`11 se Becks 19f LPD recaId5. PE Sc Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO Dy Cash Remitted Service Request# `1d 11 it S$� 12 2B Za X00 30� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18