SR0084168 - 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-KEFUNDABLE PERMIT (:ALL (ZU.9) 9b3-/ti91 FOR INSPECTIONS EXPIRESe1 YEAR FROM DATE ISSUEI JOB ADDRESS L4={ 13 fA -y Lri ` CITY/ZIP —L n.(, G� CROSS STREET �IL b h4 ry11. APN v ^ D LlA — - -S PARCEL SIZE OWNER NAME hb2-tid=A p kn.. 11 J PHONE p OWNERADDRESS y—Zg �-/\ �T _ CITY/STATE/ZIP CONTRACTOR win ( I IL�t.�GS �.C{C i�� { _/ Q f PHONE I,_n7c - CONTRACTOR ADDRESS 1°�s-�r>>C Lf q�U�� CITY/STATE/ZIPG✓LQt LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER(0< ppJS� EXPIRATION DATE ��' aaCt77 WATER TABLE DEPTH: I ` ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # a I 1 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ).rgr f ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 1 Soo "i NUMBER OF EMPLOYEES: 7 &K -SEPTIC TANK TYPE/MFG d V CAPACITY 'a gal # OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft PROPERTY LINE �) ft DISTANCE TO NEAREST: WELL 16D-- ft FOUNDATION ( ft PROPERTY LINE (Cir ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS # OF LINES �_ LENGTH OF LINES . 7� ft ll DISTANCE TO NEAREST WELL f l5 6 *7 ft FOUNDATION (O 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 1 WIDTH �L 11 ft DEPTH 9'5 -1 ft DISTANCE TO NEAREST WELL ft FOUNDATION I p ' ft PROPERTY LINE ' (7 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. J DEPARTMENT.USE ONLY Application Accepted Date d 31 4;!�`' i Area Li Employee ID#_ Final Inspection By0 DateVS4 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/-Smp Soil Character: COMMENTS lar v s)� r; 3 ,e .� f\j C, tee, h >7F S Iry w-de.r ff;;'1v`P'' �,7<rcC'TotZ r1T rele46 1%lety rf PE Code SC Received hec INFO ash Amount Date Permit/ Invoice # Remitted Service Request # Permit ID# ll tI 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18