SR0083398 - Laserfiche WebLink

Home Browse Search

®NSITE 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 �Ei�� DI_C/��113 I�tiC..r jCITY/ZIP lIY1J��t�J� %� CROSS STREET CCJ;v1 Sir z,.E � �- APN � � J I � �O � PARCEL SIZE � L'vr� OWNER NAME / i7'YJ �'yY�jJ'1� PHONE �� jZ�r' 3G� l OWNER ADDRESS Si�YN� CITY/STATE/ZIP CONTRACTOR CONTRACTOR ADDRESS J LICENSE ❑�42 ❑IAC -36 OTHER WATER TABLE DEPTH: 1 3b ❑ FERC TEST # [ TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPLACEMENT PHONE �Crs�1'"SZ1Z� CITY/STATE/ZIP NUMBER ��.% EXPIRATION DATE O'r9/�/ ft GEOGRAPHICAL INFORMATION: COOrdlnateS X BUILDING PERMIT # INSTALLATION WILL SERVE: i� RESIDENCE NUMBER OF LIVING UNITS: �— SEPTIC TANK ❑ GREASE TRAP LAND USE APPLICATION # Y REPAIR/ADDITION LJ ENGINEER DESIGNED CI OUT -OF -SERVICE SEPTIC SYSTEM .�I DESTRUCTION ❑ COMMERCIAL � "'� � ❑ OTHER NUMBER OF BEDROOMS: S ?bls•sYs � 1 �� .Ss�iJBS �? .Lh.-.-. „� NUMBER OF EMPLOYEES:_ TYPE/MFG DISTANCE TO NEAREST: WELL JGY�'�" ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ �- LEACH LINES ❑ FILTER BED ❑ MOUNDED ❑ LEACHING CHAMBERS DISTANCE TO NEAREST WIDTH DISTANCE TO NEAREST WELL fUG >` ft ft LENGTH WELL ft WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft WIDTH � ft LENGTH DISTANCE TO NEAREST WELL �`' ft SERNATIVE CAPACITY �Z� �� gal # OF COMPARTMENTS CAPACITY / gal # OF COMPARTMENTS FOUNDATION /�% � ft PROPERTY LINE /CXR • ft PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) _ # OF LINES �_ LENGTH OF LINES � �� FOUNDATION %S' ft PROPERTY LINE SZ'i� Y' ft ft DEPTH FOUNDATION ft ft PROPERTY LINE DEPTH FOUNDATION ft � ft FOUNDATION -�3� ft ft ft ft PROPERTY LINE ft DEPTH j ft PROPERTY LINE �`- ft ❑ DISPOSAL PONDS WIDTFI ft LENGTH ft DEPTFI ft SAN JOAQUIN COUNTY ORDINANCES, DISTANCE TO NEAREST WELL _ ft FOUNDATION �1 ft PROPERTY LINE ft �- SEEPAGE PITS NUMBER WIDTH 6 '7 �r, /yl/ / ft DEPTH c�5 � /� ft DISTANCE TO NEA EST WELL c�0 r �� ft FOUNDATION U1O � ft PROPERTY LINE (U � ft 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. �I� � � SIGNED �� / %' DEPARTMENT USE ONLY Application Accepted By �"—��1 � vv DaU 3/// �Z1 Final Inspection By �,Sl=E�'�- 1`+M� Date L�•�Zt—Za�� Character of Soil to Depth of 3 Ft: COMMENTS ��.i �It�S �✓Si'P� f�(;;�'�m J�I�rt u s f Pit/Sump <�1�,r DATE Area I C1 � Employee ID#kJ,A ❑ SPECIAL FERMI"f -Approved by Character: PE Code SC INFO Received B Check#I Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# �I� � � lis' �'3� � 0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 `a m i 0 0 z