SR0082726 - Laserfiche WebLink

Home Browse Search

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.9) &0J -/Dy[ FOR INSI'tG11UNSS- r-AFIKtS I T tAK rKVIVI VAI t ]JJUtI JOB ADDRESS ��J �� Gr"^ } 1t� �G CITY/ZIP {\ r, - ,i C (i, '% S-3 G I 1/ O J ' 3 CROSS STREET APN OWNER NAME (r V�v`�l (� PHONE OWNER ADDRESS (�C F Xy� Se �00 CITY/STATE/ZIP CONTRACTOR \ r&C� �CGr�r �' C✓ice PHONE CONTRACTOR ADDRESS G�/� � ISx) 4, ,' `� ` CITY/STATE/ZIP LICENSE 1111C-42 ❑❑C-36 OTHER NUMBER 7©� EXPIRATION DATE >>l30laa WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: ❑ NEW INSTALLATION I] REPAIR/ADC Coordinates X LAND USE APPLICATION #. )N 0 ENGINEER DI Y .TERNA ❑ REPLACEMENT ❑ OUT -0F -SERVICE SEPTIC SYSTEM Al DESTRUCTIOI 5eP716 JY! t1 /Z, INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP. ❑ LEACH LINES - LEACHING CHAMBERS_ FOUNDATION DISTANCE TO NEAREST WELL ❑ FILTER BED WIDTH ft FOUNDATION DISTANCE TO NEAREST WELL ❑ MOUNDED WIDTH ft FOUNDATION DISTANCE TO NEAREST WELL ❑ SUMPS WIDTH ft FOUNDATION DISTANCE TO NEAREST WELL ❑ DISPOSAL PONDS WIDTH ft DISTANCE TO NEAREST WELL ❑ SEEPAGE PITS NUMBER DISTANCE TO NEAREST WELL CAPACITY CAPACITY ft FOUNDATION O PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES LENGTH OF LINES ft FOUNDATION WIDTH ft ft FOUNDATION ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 1 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. SIGNED vR nvorca. / /vlva - rL-GF1.7C V/iLL I LUJ/yo'J-/ UJ/ TITLE 'P "�SEollr- v --+ DATE wj 13 /Z.zc. DEPARTMENT USE ONLY Application Accepted B Date Area S TGtG Employee ID#� Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS of 7074CI Inl . 1, ft PE Code ft FOUNDATION LENGTH Amount Remitted ft Permit/ Service Request # ft FOUNDATION LENGTH a75 ft 23 ft FOUNDATION LENGTH ft ft FOUNDATION LENGTH ft ft FOUNDATION WIDTH ft ft FOUNDATION ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 1 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. SIGNED vR nvorca. / /vlva - rL-GF1.7C V/iLL I LUJ/yo'J-/ UJ/ TITLE 'P "�SEollr- v --+ DATE wj 13 /Z.zc. DEPARTMENT USE ONLY Application Accepted B Date Area S TGtG Employee ID#� Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS of 7074CI Inl . 1, ft PE Code SC INFO Received By Ce Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# aq l a75 23 iso w SR00 2 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T