SR0083770 - Laserfiche WebLink

Home Browse Search

A 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 JOB ADDRESS Ito CITY/ZIP r1r-c^ch G ow,P I L r* r/' m ��I PARCEL SIZE p CROSS STREET T' C itis APN fZ C� O p /� / O OWNER NAME A V.'I o, A r n^L�i/7 C� PHONE M OWNERADDRESS /h�"��h V-J<,.(I(IrPIr� R��l CITY/STATE/ZIP 1> CONTRACTOR Y `G,.��S �qq<`� a-Ti 5: �r - PHONE �" -gic,— dV�•SI CONTRACTOR ADDRESS PO VJO)c �J / CITY/STATE/ZIP y� 4Z.1tkGi9' LICENSE ❑ C-42 D C-36 OTHER NUMBER (� EXPIRATION DATE 'v WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y E PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: / NEW INSTALLATION tti3 C f REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE V REPLACEMENT b•d, G�I OUT-OF-SERVICE SEPTIC SYSTEM L/ DESTRUCTION TC',1'1 INSTALLATION WILL SERVE: E(/RESIDENCE E COMMERCIAL hJ E OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: _x1 NUMBER OF EMPLOYEES: O-'SEPTIC TANK TYPE/MFG �(� L CAPACITY [6-VD gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY � gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ' Do' ft FOUNDATION 4b 1 ft PROPERTY LINE S/ ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Ib 14, FILTER TER BED WIDTH';i,5# ft LENGTH , 3, r.�' ft DEPTH rr ft DISTANCE TO NEAREST WELL 180 ft FOUNDATION Sa, 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. MINIMUM 48 HOUR NCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 SIGNED TITLEC�O►1nL(cc-dUC� DATE17 4'z S G ti T DEPARTMENT USE ONLY r Application Accepted B �� Date SL';6 X Area + G�� Employee ID# Final Inspection By�o Date SPECIAL PERMIT-Approved by JF Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Su I •,/:r S S-f�'rn, Fl Gh(7G l?r;'�vn fil- P11' P I o '✓1 ,F i�I'1U3: L r C'a`io r( M PE SC Received eck Amount Date Permit/ Invoice# Permit ID# Code INFO B Remitted Service Request# IU �82D 3 oto s 21 S242-01 00 ' " 4/14/18 / I �v' J Y` I�"L o J :2q -C� * I O ' (, ONSITE WASTEWATER TRTMNT SYSTEM PERMIT