SR0081763 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-KEFUNDABLE PERMIT JOB ADDRESS � CROSS STREET/-4J"/f� �1 , n OWNER NAME_ OWNER ADDRESS CONTRACTOR CONTRACTOR ADDRESS LICENSE ❑'. C-42 ❑ 'C-36 OTHER •/Gy/ FOR INSPECTIONS tXPI ES 7 TEAR FROM UATE ISSUEI ITY/ZIP 3 f U APN 197 ' — v /�(' (P PARCEL SIZE 2,qq 4 PHONE ``� /✓� �� / / CITY/STATE/ZIP PHONE CITY/STATE/ZIP NUMBER EXPIRATION DATE n ❑ LEACH LINES LEACHING CHAMBERS X Cash WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # ft zZ BUILDING PERMIT # LAND USE APPLICATION # WELL TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED /ALTERNATI E ft PROPERTY LINE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTIONtn� INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: DEPTH ❑ 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 X Cash Amount I Remitted # OF LINES Permit/ Service Request # LENGTH OF LINES ft zZ d DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH It 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 It PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It 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 CERJ,LFi' AT I HAVE PREPARP THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, TATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. v vmru I o n urC yr/vt.0 Ivtlllt r: rNa ulrCcu run IIv r-Ct.1IVl .� - rL-croc 14v .700-1N.71 SIGNED II ..� TITLE DATE 2-11 g Zd Application Accepted By%11 Final Inspection By1n� Character of Soil to Depth of 3 Ft: COMMENTS l Date I c v z JSEIONLY `� Area ��a Employee ID# %� ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE Code SC INFO Receivedec Y. X Cash Amount I Remitted Date Permit/ Service Request # Invoice # Permit ID# zZ d z I 3 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/16