SR0083872 - Laserfiche WebLink

Home Browse Search

TA 1,) ONSITE 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 SIGNED :SS3110UV 31IS JOB ADDRESS 2 34 ir 4, E. • atrE.N VI STA /2:1> • crryizip C VV1 ENT'S CROSS STREET WWII Si APN 0 10 - PARCEL SIZE OWNER NAME TED %Ai I LI./ AlAn S PHONE 'fir I "1-rifto OWNER ADDRESS I 3 F 're L 1,K3 • CONTRACTOR LIVC 0,114 G-E0 114b#41%11 NT'AL CONTRACTOR ADDRESS 110 / to-I • 0 AK ST. crryisTATEizip G-s°0-7 0IN I no 3 2. PHONE 3 Ut 0 3 1 S- crryisTATEizip CA S 2 'I-O LICENSE L C-42 L.1 C-36 OTHER C Go" NUMBER 2. Ir I EXPIRATION DATE Li- -30 -2- Z ft GEOGRAPHICAL INFORMATION: Coordinates X BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPLACEMENT REPAIR/ADDITION OUT-OF-SERVICE SEPTIC SYSTEM . ENGINEER DESIGNED /ALTERNATIVE . DESTRUCTION INSTALLATION WILL SERVE: 11 RESIDENCE I I COMMERCIAL E OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: X PERC TEST # WATER TABLE DEPTH: fir 0 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 LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) ft LEACH LINES . LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 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. MINIM=AIRMANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 TITLE /42•0i • f)*t DATE Ze -14 2-- I PE Code SC INFO Received By Cash tQ t.9.0c*/ Amount Remitted Permit/ ate Service Request # Invoice # -vy Permit ID# WP'( Aii-i I 52, LP 24 5-40r63Y P EPARTME 6/11 SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: COMMENTS A Area Application Accepted By Final Inspection By r C1/4 e _ASA. A Date Date T USE ONLY On- Oli Employee ID# et) 81441 ° I/CQ ifibN N Co 7./ h 4 414i meivr 1.1 Pit/dump loil Character: 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18