SR0084263 - 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)953-76^97 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS /Z�� ``elAl Sy �TG /✓ K,� CI/TY/ZIP A C y / CROSS STREET ��U^I D S,�h�� APN (909 j�-1 b 0) 0 PARCEL SIZE F7 OWNER NAME_ S J �7C'�/C (� PA) R A N n N � -'9 w _PHONE ? — / OWNER ADDRESS LfS -1 �Jn/ OS�&i1��bn CITY/STATE/ZIP _ � CONTRACTOR C lL,1� r^E` Dfe1))2 ?Iom lJlY)G PHONE c CONTRACTOR ADDRESS ir ` L�Y LS (t L � CITY/STATE/ZIP l �7 9,53 U LICENSE DDC-42 _IC-36 OTHER NUMBER /7 EXPIRATION DATE 10/31/ WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y 0 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION Ei REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE D REPLACEMENT D OUT-OF-SERVICE SEPTIC SYSTEM U DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ElOTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: & NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG C e-'-V Co'Ti 'TTS CAPACITY 2G G p gal #OF COMPARTMENTS d ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS & DISTANCE TO NEAREST: WELL J50 ft FOUNDATION ft PROPERTY LINE a ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES Al LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft `FOUNDATION ft PROPERTY�NE ft FILTER BED WIDTH 2 7 ft LENGTH 3 ft DEPTH �2 t ft DISTANCE TO NEAREST WELL I � ) ft FOUNDATION 1"0 ft PROPERTY LINE I 0 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 WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft 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. UM 48 H R ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 , SIGNED 4 TITLE C-Ao' 7 Z'��n p DATE 7 J ,q17 7 6t in t -rilO a M U l DEPARTMENT US ONLY _ �� P 'T Nr Application Accepted By �Li Date 97 q? Area J Employee ID# Final Inspection By `J Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: COMMENTS Sr'c.'nC) cl,ni} d vie 111 ny r PE SC Received Chec Amount Date Permit/ invoice# Permit ID# Code INFO By Cash Remitted Service Request# y 1 I I`7 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18