SR0083422 - Laserfiche WebLink

Home Browse Search

it ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT ,�,/��,,GALL ZU'J Yb3-/b'J/ FOR INSPECTIONS tXPIRES l YEAR FROM DATE ISSUEI 1.. JOB ADDRESS +IOT2 . lT•`W^Owy 61coVr- LN - CRY21P Ljy C44E1b1Zj> c/A 11S'Z3`1 CROSS STREET I �'E�EW /A 4 ,�y� APN PS 1 + y ¢L) - 3 `•' PARCEL SIZE Z' 5 �l ` OWNER NAME CovSEl r wrzyc-e S N+ D�2 PHONE 110 --1 17 OWNER ADDRESS I 1 S•I O N . / -E rV1Vkj!" CRY/STATE/ZIP / LoG EGD GA SZ31 CONTRACTOR LIVC 00%V- Gi0E✓yGA'�k/16ZMC/V 7rr�dr'� - L-- PHONE 3 VG ! -o 31f- CONTRACTOR ADDRESS d4o1 W • PAY- ST'• CITY/STATE/ZIP L-00 l � Chi 9 F2 4C7 LICENSE ❑;.,C-42 11i.::',C-36 OTHER LCG NUMBER y+� + EXPIRATION DATE y ` 0 - 2.2 - WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # (BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM : DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS DISTANCE TO NEAREST WELL ❑ FILTER BED WIDTH It LENGTH DISTANCE TO NEAREST WELL ❑ MOUNDED WIDTH It LENGTH DISTANCE TO NEAREST WELL ❑ SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ❑ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ❑ SEEPAGE PITS NUMBER WIDTH_ # OF LINES ft FOUNDATION ft FOUNDATION ft FOUNDATION It FOUNDATION ft FOUNDATION DISTANCE TO NEAREST WELL ft FOUNDATION LENGTH OF LINES ft It PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE It It DEPTH ft ft PROPERTY LINE It ft DEPTH ft It PROPERTY LINE It ft DEPTH ft ft PROPERTY LINE It _ft DEPTH ft 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. MINIMLWO IUOUR AQUANCEN T E /RED FOR INSPECTIONS LL 2 953-ZO7 SIGNED TITLE 102-0.3 ' I%'t GIS • DATE 3 DEPARTMEN USE ONLY ! n Application Accepted By Date �j3j /q? Area -7 I Employee ID#_ D14 Final Inspection By f c . 1 L' wil6 �� Date "1 1 L� 1 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Amount Date Permit/ Invoice# PermitID# Code INFO Ay ash Remitted ice Re uest # L aaa sa3 15� 2 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 NNr Fo o?1 Nry /T