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SR0083250
EnvironmentalHealth
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JAHANT
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4200/4300 - Liquid Waste/Water Well Permits
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SR0083250
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Entry Properties
Last modified
6/15/2021 10:28:04 AM
Creation date
6/15/2021 10:12:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0083250
PE
4222
FACILITY_NAME
13044 E JAHANT RD
STREET_NUMBER
13044
Direction
E
STREET_NAME
JAHANT
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
00727046
ENTERED_DATE
2/8/2021 12:00:00 AM
SITE_LOCATION
13044 E JAHANT RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\dsedra
Tags
EHD - Public
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PHONE (91(44) "'Pi 1 • 4-351 <br />CITY/STATE/ZIP AC Alovki7 to eA 5- <br />JOB ADDRESS 1301+4 E.. ) Ao-hbrAJ -r ra-D • crryizip Ac.Awt p 0 1 <br />CROSS STREET 6-R-A 1.tA tev• APN 001- 2-10 -44b PARCEL SIZE 4. 6? otict • <br />OWNER NAME Al2..11) la° L. E.V VA <br />LÀ <br />7-2.- I. co Lump- . <br />%) E 0 !kg_ CrEDEN.Jv ii?-0 "NJ vvq....fT el L._ <br />CONTRACTOR ADDRESS 440 1 tA) • 0 A K. . <br />LICENSE C C-42 C C-36 OTHER C NUMBER 2.1 5" I <br />OWNER ADDRESS <br />CONTRACTOR PHONE <br />CITY/STATE/ZIP LO) I CAA 2.',¼ <br />EXPIRATION DATE 4.4" - 2.2. <br /> <br />,( <br />Date 02/41? d ( Area 9/qg Employee ID# <br />Date 1 E SPECIAL PERMIT - Approved by <br />it/Sump Soil Character: <br />DEPARTMENT,L1 E ONLY <br />Character of of Soil to Depth of 3 Ft' <br />,$44, 08 <br />ig2 <br />Application Accepted Accepted Bt „ <br />Final Inspection By H. • <br />COMMENTS <br /> c%1111" <br />4421 ki -147•At /0 <br />°4- Ity7°447). <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - SrocKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> <br />WATER TABLE DEPTH: <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # :SSMIUCIV 31IS ENGINEER DESIGNED/ALTERNATIVE <br />DESTRUCTION <br />_ OTHER <br />NUMBER OF EMPLOYEES: <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LENGTH OF LINES <br /> ft <br />ft PROPERTY LINE <br /> ft <br />DEPTH <br /> ft <br />ft PROPERTY LINE <br /> ft <br />DEPTH <br /> ft <br />ft PROPERTY LINE <br /> ft <br />DEPTH <br /> ft <br />ft PROPERTY LINE <br /> ft <br />DEPTH <br /> ft <br />ft PROPERTY LINE ft <br />ft DEPTH <br /> ft <br />ft PROPERTY LINE <br /> ft <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: RESIDENCE <br />NUMBER OF LIVING UNITS: <br />COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 <br />0 <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG CAPACITY <br />TYPE/MFG CAPACITY <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL ft FOUNDATION <br />OF PUMP 0 PKG TX PLANT CI <br />0 LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br /># OF LINES <br />WELL ft FOUNDATION <br />U FILTER BED WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />U MOUNDED WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />SUMPS WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />U DISPOSAL PONDS WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 SEEPAGE PITS NUMBER Mom <br />DISTANCE TO NEAREST WELL ft FOUNDATION <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 />SIGNED TITLE P 11-0 • )44 6ri2 DATE 2.. - 1?- 2. 1 <br />MINIMUI=RAIANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />d.F.9 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />heckY <br />Can <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />`12R a 5023 <br />64,775, <br />i 62,60, () 4; is- g• 8 -2-1 SR(X)13.s0 <br />42-01 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18
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