SR0083354 - Laserfiche WebLink

Home Browse Search

J111111111 - ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 IVUN-RtrUNUAt3Lt rhRMIT (;ALL LU9 53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESSVAF::�OCITY/ZIP CROSS STREET APN aN I - `10U - 3 PARCEL SIZE OWNER NAME AA L k -I ri 1t� L_cj-hry C 2, I C- C ( I - 2GN� PHONE (- OWNER ADDRESS 3ICITY/STATE/ZIP c.^ Faz1SCc n CA 9 i..l l C= l CONTRACTORiL �_✓��^VJI I -C.-\ ^ tT t �, 7 Q PHONE r�J`t - (-I3, -O(P60 44 CONTRACTOR ADDRESS DCS S HW Y7 V 7�/D �` CITY/STATE/ZIP S L k 'iT�h I &A Cis L I S 0 LICENSE 11 11C-42 El LIC -36 OTHER L -�1 (a NUMBER q'i EXPIRATION DATE 3 ` �a WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: ] NEW INSTALLATION Ll REPAIR/ADI Coordinates X LAND USE APPLICATION #_ IN L ENGINEER DE ❑ REPLACEMENT L OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Y INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP TERNATIVE CAPACITY gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINE ft . ❑ PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES 1-1 LEACHING CHAMBERS Received B Check#/ Cash # OF LINES Date Permit/ Service Request # DISTANCE TO NEAREST WELL ft FOUNDATION ❑ FILTER BED WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ MOUNDED WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SUMPS WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SEEPAGE PITS NUMBER WIDTH ft DISTANCE TO NEAREST WELL ft FOUNDATION LENGTH OF LINES ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 1 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. MINIM 48 HPUR ADVANCE NOTICE REQUIREDFOR IN ETI N- PLEASE CALL 20 -76 7 SIGNEDTITLE DATE 3 / 3 % � 1 Application Accepted 1 Final Inspection By_ Character of Soil to De COMM ENTS 't.,Y--1 of 3 Date W, °v Area Date I 0 ( ❑ SPE Pit/Sump Soil Character: Employee ID#AVl1M IAL PEROT - Approved by PE ode SC INFO Received B Check#/ Cash Amount emitted Date Permit/ Service Request # Invoice # Permit ID# Z. 732 42-01 /% n, /"7 / % SZq ( ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 �j� LSI V J r/ T