SR0084486 - 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 EXPIRES 1 FROM DATE ISSUED JOB ADDRESS p 0 ^ f•)C'UI3 11/� {t CITY/y� / •L11 !(y� tYEAR ) [°�G1 , (4,�I q S 2^ t/' CROSS STREET L� i �[� J� �I: 1 /� iJ {� 7 �r� APN (, 2 �/ `ZIP L% p/ %� L7 '7 LO PARCEL SIZE L�•7 OWNER NAME } �1 ):-r► J�57�nn/N n PHONE 2�—� 3 _,�- ' W6, OWNER ADDRESS Iy2� 5. t/71L1 CITY/STATE/ZIP 1 NEAREST SEEPAGE PITS NUMBER DISTANCE TO CONTRACTOR �{ -� PG)CrI1 1'1 y /�r/IPf;I/1vI 1p1Z1hi/i( C 1. 7F-NlfC IvY. PHONE -2 CONTRACTOR ADDRESS 4a I. 3 _ _ c -,,)h) Parr, s e IA/Av% ! L"j C CITY/STATE/ZIP I'".Vl s 3 S LICENSE ❑LIC -42 [10C-36IC-36 OTHER `� /r NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION CI REPAIR/ADDITION r1 ENGINEER DESIGNED /ALTERNATIVE Ci REPLACEMENT ❑ OUT -OF -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 CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS # OF LINES LENGTH OF LINES I HEREBY CERTIFY THAT I HAVE SIGNED WELL ft LENGTH WELL ft LENGTH WELL ft LENGTH WELL ft LENGTH WELL WIDTH ft FOUNDATION DISTANCE TO NEAREST FILTER BED WIDTH Date Permit/ Service Request # DISTANCE TO NEAREST MOUNDED WIDTH ft ft FOUNDATION DISTANCE TO NEAREST SUMPS WIDTH DISTANCE TO NEAREST DISPOSAL PONDS WIDTH DISTANCE TO NEAREST SEEPAGE PITS NUMBER DISTANCE TO NEAREST I HEREBY CERTIFY THAT I HAVE SIGNED WELL ft LENGTH WELL ft LENGTH WELL ft LENGTH WELL ft LENGTH WELL WIDTH ft FOUNDATION SC INFO Received By ft ft FOUNDA14ION Date Permit/ Service Request # ft ft FOUNDATION Baa sa3 ft ft FOUNDATION �►sa -I - ft ft FOUNDATION ft WELL ft FOUNDATION ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. )-i DATE Ii(/ ft ft ft ft ft ft ft ft ft ft ft ft DEPARTMENT US.E ONLY _ Application Accepted By �� Date II )C Area S rI?417" Employee ID#_A Final Inspection ByDate Z F1 SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Achl ed ffkI e1 sev'e"' CcD;loc Ioi-i is P 0s+gyp. .1l7: r. �V Ill�llfs, it1IN./L(- SLw.�nw 1e�1 IDuAitA �i7•Lti5ivt = 1( +µi:u_ it -A4 ! D0;'5L4� PE Code SC INFO Received By Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# Baa sa3 �►sa -I - S '8q* 42-01 C l ; 744{ � ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 v :.I n