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 QCALL 220'9)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS X66-1 S O 5/ C A✓ R h CITY/ZIP � G y CROSS STREET llUi✓ -1/ APN ao '1 b❑ O PARCEL SIZE b p OWNER NAME LA K71vca S.4-,jH—NRsM)_ RANn�jwA PHONE �"9— el k44 OWNER ADDRESS / 71/S-t'{'� V`J/f/ j�) S D S-�L3.r/!M CITY/STATEIZIP L J, CONTRACTOR C"\ C� .IJ'te4 w � r10 Wil-l Y14 PHONE n� CONTRACTOR ADDRESS O a N�L 27 CITYISTATE2 ^1P `& L-T LICENSE 110C-42 �C-36 OTHER NUMBERa 0/ EXPIRATION DATE I0l3>'/� WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST #� BUILDING PERMIT# IG(16 a gip LAND USE APPLICATION# TYPE OF WORK: Ve NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT iI OUT-OF-SERVICE SEPTIC SYSTEM C DESTRUCTION INSTALLATION WILL SERVE: OIRESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 9� NUMBER OF BEDROOMS: & NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG C.-y Co"4!f CAPACITY 2.,G d gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG / S CAPACITY gal #OF COMPARTMENT DISTANCE TO NEAREST: WELL /5V it FOUNDATION 2f ft PROPERTY LINE Sl ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYtf JNE /l P-IFILTER BED WIDTH 27 1 ft LENGTH 3 a ft DEPTH 4t t It DISTANCE TO NEAREST WELL I:5 O It FOUNDATION I'O ft PROPERTY LINE to ft ❑ MOUNDED WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST W ELL It FOUNDATION ft PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION /l PROPERTY LINE it I HEREBY CERTIFY THAT 1 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 V NCE NOT ERE RED FOR/ P TIDNS-PLEA E CALL 2 9 9 3-7 97 SIGNED TITLE C A-Z04 C^7dI DATE ! 7-7 21 It 1111t DEPARTMENT US& ONLY _ Application Accepted By [�� Date 477 Area a —I Employee ID# Final Inspection By Date I Dill Z ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 11 Ft: Pit/Sump Soil Character: COMMENTS r.4 dijeI I i rw� ` i IZl - i16-k %;k'7 C-ol 0i� C U�i�i�W� v' �vwt lu OJ✓� `I UL � keU. eG L L ip+� Pe SC I Received hec Amount Date Permit/ Invoice# Permit ID# Code INFO B ash Remitted Service Request# ya I il7 Is8 a� 5r2� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18