SR0084290 - 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 (:ALL ZU9) 953-/69/ FOR INSPECTIONS t=XPIRES 'I YEAR FCROM UATE ISSUEI JOB ADDRESS CITY/ZIP ,L� _ f S CROSS STREET �J w � v _ APN L,z � ` 1 `-' o L 1 PARCEL SIZE o OWNER NAME t f G7 �' //,,,s e 6 � s �' I PHONE OWNER ADDRESS e / / Z Z / ^eo CITY/STATE/ZIP CONTRACTOR 1� Q e PHONE CONTRACTOR ADDRESS X�7 / N -e 11.a 1l, / &t CITY/STATE/ZIP LICENSE IC -42 ❑I.1C-36 OTHER NUMBER �V EXPIRATION DATE WATER TABLE DEPTH: V ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG CAPACITY I CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ LEACH LINES LEACHING CHAMBERS `co+ ft LENGTH LENGTH LENGTH LENGTH WIDTH y gal # OF COMPARTMENTS �`— gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES LENGTH OF LINES _ FOUNDATION 104 ft PROPERTY LINE ft DEPTH ft FOUNDATION DISTANCE TO NEAREST WELL ❑ FILTER BED WIDTH ft ft FOUNDATION DISTANCE TO NEAREST WELL ❑ MOUNDED WIDTH ft ) DISTANCE TO NE REST WELL ft FOUNDATION SR OWA ft PROPERTY LINE ❑ SUMPS WIDTH ft ft FOUNDATION DISTANCE TO NEAREST WELL ❑ DISPOSAL PONDS WIDTH ft ft FOUNDATION DISTANCE TO NEAREST WELL ❑ SEEPAGE PITS NUMBER DISTANCE TO NEAREST WELL `co+ ft LENGTH LENGTH LENGTH LENGTH WIDTH y gal # OF COMPARTMENTS �`— gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES LENGTH OF LINES _ FOUNDATION 104 ft PROPERTY LINE ft DEPTH ft FOUNDATION SC INFO ft PROPERTY LINE Check#/ Cash ft DEPTH ft FOUNDATION Invoice # ft PROPERTYL ) ft DEPTH ft FOUNDATION SR OWA ft PROPERTY LINE ft DEPTH ft FOUNDATION ft PROPERTY LINE ft DEPTH ft FOUNDATION ft PROPERTY LINE �J 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. SIGNED / If -1/r ;00-;rlI/ TITLE awh eil1A 4r n" DATE Application Accepted By Final Inspection By Character of Soil to Depth of Ft:_ COMMENTS -Frc Vt Lf T M E N T USE ONLY `G Date �� Z 7-0 2- 4rea � ( i (? Employee ID# Date/y 2 ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE Code SC INFO Received By Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# U SR OWA 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 rM v d