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SR0083555
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4200/4300 - Liquid Waste/Water Well Permits
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SR0083555
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Entry Properties
Last modified
6/7/2021 1:30:33 PM
Creation date
4/26/2021 9:49:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0083555
PE
4202
FACILITY_NAME
20888 HENRY RD
STREET_NUMBER
20888
STREET_NAME
HENRY
STREET_TYPE
RD
City
ESCALON
Zip
95320
APN
24915019
ENTERED_DATE
4/14/2021 12:00:00 AM
SITE_LOCATION
20888 HENRY RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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Tags
EHD - Public
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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQU IN COUNTY ENWROXVIENTAL HEALTH i3EPARTMENT 304 E WEBER Avc - 3" rL • STOCKT'ON CA 95702 - (709) 46SJ420 <br />]PIAN-KEFDNDABLE PERMI <br />T <br />(:A1.1.42091953 -7697 FOR ItiPk['TI(115 EXPIRES I YEAR FROM DATE ISSDCD <br />3O8 ADDRF83 O tig e-4 R,� i_ "� CFFYfLIP w3f c <br />CROSS STREET O r. r+s-7 _ APN_.rt _ 1 GI PARCELSIx£ <br />OWNER NAME , ok A /iV. i 'L PHONE <br />OW'NERADDRESS I(S D P —'YIC7fr,--_CITY/STATEPLIP C ;- <br />CONTRACTOR i1-VIs &-,A� k Le,— PHONE <br />CONrRAcrORADORE&S � 6 6"k .. �.�_. IlTYMA'rtJxtP M r GLS__: _3 GG•_ <br />LICENSE O C-42 ❑ C•36 OrNkit r tit MRF.R E%PI RAT ION DATE <br />1 y <br />e <br />A <br />Ioc <br />-A-- IA.,. - n: It <br />4EDGRAPHICAt.INCGRKIXrlON: Cvordinaics x <br />Y <br />CAPACITY 1�6 ha gat : UFCOMPARTMENTS_-�-_ <br />❑ GREASIETRAP <br />❑ PERC TEST (S) NUI.yt <br />LANO Use APPI. R:AT]ON 9 <br />CAIACITY bat MpP CAUPA RTMF.HTS <br />a PKC TX PLANT <br />DfS7'ANCE TO NEAREST! <br />TYPE OF WORK: 9- NEWINSTALLATEON <br />❑ REPAIWADDITION <br />O F,?IGINEARDESICNEDIALTERNXTIV£ <br />111 MILLf <br />_sCj <br />D REPLACEMENT <br />❑ DESTRUCTION <br />SIZE <br />Type Of PUI4r <br />❑ SAND OIL SEPARATOR (E gctoseu SYS7Fx) <br />L" LE 1ClI LFNES <br />17 LEACHING CHAMBERS <br />p of LINES :iL � LENOTIl OY 1- iNcs <br />CQ <br />1N5TALLA710N WILL SERVE: RESMENCE <br />❑ COMMERCIAL <br />❑ UT}IeA <br />w— <br />fl LENOTH _ <br />%lu MRER OF' L1viNc. L•N m: <br />NOM HF.R OF $ER ROOMS'. <br />NUMBEROr F <br />WELL Il <br />POUNDA71024R PROPERTY LINE R <br />Or -SEPTIC TANK <br />TYPEIMFG Y <br />CAPACITY 1�6 ha gat : UFCOMPARTMENTS_-�-_ <br />❑ GREASIETRAP <br />TYPE/WG <br />Amount <br />CAIACITY bat MpP CAUPA RTMF.HTS <br />a PKC TX PLANT <br />DfS7'ANCE TO NEAREST! <br />I <br />WF,I.I R <br />r <br />�_ <br />42.11 <br />111 MILLf <br />_sCj <br />FoutiUA'rinN f! PxoPl.trrr LItiE <br />❑ LIFT STATION <br />SIZE <br />Type Of PUI4r <br />❑ SAND OIL SEPARATOR (E gctoseu SYS7Fx) <br />L" LE 1ClI LFNES <br />17 LEACHING CHAMBERS <br />p of LINES :iL � LENOTIl OY 1- iNcs <br />DISTANCE TO N! Ll RLS7 <br />WELL di n <br />FOUHDAMOS 1 4 1 it PROPERTY Lwr <br />❑ CILTER DED <br />w— <br />fl LENOTH _ <br />R DEPTH_ tt <br />MsTANCETONEAREST <br />WELL Il <br />POUNDA71024R PROPERTY LINE R <br />Q MOUNDED <br />WIDTH <br />it LE10TH <br />R IX -PTH <br />DISTANCETONEAREST <br />WELL R <br />FOUNDATION_ R PROPERTY LINE <br />] SL'MPs <br />WIDIN <br />R LENGTII , <br />R Dr PTR R <br />DISTANCETONEAREsr <br />WELL Il <br />FOl:NDAT10' fl PROPERTY LINE ti <br />❑ DISPOSAL PONDS W1MH _ <br />ft LENOTf[ <br />H DEPTH R <br />DISTANCE TO NEARESY <br />WGLI. fl <br />FoL]tiryAT:ON 1t PROP[RTY LINE R <br />C3 SEEPAGE PITS <br />WIDTH <br />A I.SNGTH <br />R DEPTir El <br />Dt$TANCCTONEARR$T <br />WeLl. R <br />FOUA;DATION R PROPWY LINE tl <br />I HEREBY CERTI FY THAT I HAVE PRL PA It VP THIS APPLICATION AND TRE Wt IRK WILL DE DONX IN ACCORDANCE. WITH SAN JOAt2UIN COUNTY 0R13IN ANCESi, <br />STATE LAWS AND RULF.S AND RF.CI'LATIO NS OF SAH JOAOUIN COD NTP. <br />TT <br />1)EPARTh1EXT I: NF. OMA' l <br />Applkatloa Arcepeed Pry pxfr Ll - i - J AFOR _ -2 -1 F.mployce ID4__�'1 J <br />FImI IRrpectf6R By _ Pate 7 � O _ M SPECIAL PERMIT-Appruved by " <br />Cha "tier ef.%iI tpth o Y: itlSump SoiE (�hRratfert <br />COMMENTS <br />41-0] .00I <br />Im,w ONSITE WASTEWATER PERMIT <br />PE <br />SC Recelved ChcckW <br />Amount <br />hate Perrnld Iaveite A Pumalt IDA <br />Cade <br />IMFO <br />Remlued <br />FArvice R L N <br />42.11 <br />111 MILLf <br />31t <br />D S <br />41-0] .00I <br />Im,w ONSITE WASTEWATER PERMIT <br />
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