SR0083907 - 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 CALL (209) 953- 7697 FOR INSPECTIONS -7 cEXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �Ze4 bp4 �' � � E 7`� - CITY/ZIP I I `- N` j V3 04 CROSS STREET L- m'-" IS wi ,J n 2 AP � ru - I � � � 2 PARCEL SIZE to • LP prG /A-c OWNER NAME ✓ AL � -TrN r -� Sr ` �,' " � L�, I ^PHONE OWNER ADDRESS y�9 (zEti TON yv 1 ` ter CRY/STATE/ZIP (f A . %Ti ✓ NLLEV CA CONTRACTOR o VE OAV1 C• ' oENy12oNW1CNTAL PHONE 3mS - 03 "1 ) CONTRACTOR ADDRESS O !4 S I CRY/STATE/ZIP L - O D t C' A � LICENSE ❑ , , C42 L11C-36 OTHER b/`C t NUMBER 21 L EXPIRATION DATE 3O WATER TABLE DEPTH : ft GEOGRAPHICAL INFORMATION : Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK : U NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE 0 REPLACEMENT 1 OUT-OF-SERVICE SEPTIC SYSTEM L1 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 fl FOUNDATION It PROPERTY LINE It ❑ 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 fl PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE f( ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH It DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUt.IBER WIDTH It DEPTH It DISTANCE TO NEAREST WELL It 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 411 OUR ADVA//N''E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953- 7697 SIGNED TITLE rPfle- 0j DATE (0 ZU - Z l _ DEPARTMENT USE ONLY Ll Qj& Application Accepted By ��/� L� Date CwtM ) Area A) C1Employee ID#i 7h�Fp RF/t/�CHry Final Inspection By Date ❑ SPECIAL PERMIT - Approved by TMFN Character of Soil to Depth of 3 Ft : Pit/Sump Soil Character: T COMMENTS PE Sc Received hec Amount ate Permit/ Invoice # Permit IDi Code INFO B ash Remitted Service Request # L1 � ? 5"� 3 rI 515 - 2 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18