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SR0083512
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0083512
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Entry Properties
Last modified
2/4/2022 7:56:06 AM
Creation date
6/7/2021 1:28:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0083512
PE
4210
STREET_NUMBER
20888
Direction
E
STREET_NAME
HENRY
STREET_TYPE
AVE
City
ESCALON
Zip
95320
APN
24915019
ENTERED_DATE
4/6/2021 12:00:00 AM
SITE_LOCATION
20888 E HENRY AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JQAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZE LTON AVENUE-STOCKTON CA 95205-(209)46W420 <br /> NON-REFUNDABLE PERMIT CALL 249 953-7697 FOR INSPECTfONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS r9'sy-s7S p�nnf well- JCITY0F LA <br /> CROSS STREET_T]�♦�hMC7 APN 9 Cf I S D) PARCEL SIZE *r+ <br /> OWNER NAhfE_ti..3 0,r-h L PHONE `l�l_��.✓t� r <br /> OWNER ADDRESS _3C3OJ❑ Ote -iri e_AyQ _ Cr"/S7 'jzP <br /> CONTRACTOR r.7%d_Y)'eK <br /> / PHONE <br /> CONTRACTOR ADDRESS CITYISTATEIRJ P <br /> LICENSE ❑`.•C-42 UCC-36 OTHER NUMBER E]CPIRATION DATE <br /> WATER TABLE DEPTH: SL� Q) It GEOGRAPKCALINPORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDTHG PERhtlIT# ,7+�7S LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEwINSTALLATION J[ REPAIRMODITION C ENGINEER DESIGNEDIALTERNATIVE <br /> REPLACEMENT S E <br /> OUT-OFSEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPFIMFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SANT]OIL SEPARATOR[ENCLOSED SYSTEM] <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES 91Z) ft <br /> DISTANCE TO NEAREST WELL " It FOUNDATION rn 0-1. _ft PROPERTY LINE R <br /> ❑ FILTER RED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST %JELL It FOUNDATION ft PROPERTYLINE _ R <br /> 13 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LI �+ ft <br /> ❑ SUMPS AMoTR ft LENGTH R DEPTH Cu R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTYLUinR <br /> 13 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTHtt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERT It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTHft <br /> H RDA1..CCL <br /> fi�Llf' <br /> D157ANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE �A�F2T. fl <br /> I HEREBY CERTIFY THAT E HAVE PREPARED THIS APP LICAMN AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY OROINANC ES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> NII,N_l,MU 48 HOUR AD�VAf+�1"NOTICE REQUIRED Fog INSPECTIONS-PLEASECAt-L(209)953-7697 <br /> SIGNED �� �, TITLE LWh...r DATE ���? <br /> I <br /> -r6 4 <br /> D E P ADate N r re <br /> S v �o <br /> Aa C� Frnployee 10# &--2 <br /> Application Accep <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of So ept1h 3 t: Pi ump Soil Character: <br /> COMMENTS Q 7Tr)�Jn o tMl'cI I]r�r7aOhl. A foveG� Ylr�l iiVI& InLctweE'+l I�v��$. <br /> Lx'I -Ipct he*e ¢,� be Iemdvs'c� c1n5v 1hl 'pe{Ffined- p-,P-Jvt,11-1 !may Pe - . - <br /> PE Sc I Received Chec"q Amount pate PermlU Invoice# Permit TD# <br /> Cade INFO B Cash Remitted Service uest# <br /> ROD e3-S)o7 <br /> 42-01 PPr Sje,eri s��k cieeglf 00y1yWY1 Pivwl S�c70g�55',5"vd'.5 <br /> 4M4MO v1pphedfe AR PgIIx& $RaOS'3s5S hod roe JIC410,;1Ok5l7EWAST'lrWATERTRTMkTSYSTEMPEF[MIT <br />
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