Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL <br />JOB ADDRESS 25267 SOUTH LAMMERS ROAD <br />953-/b9/ FOR INSPECTIONS <br />CITY/ZIP TRACY <br />r-XPIHtS I TtAH rHUM UAIt IJJUtI <br />CROSS STREET WEST SCHULTE ROAD ApN 209-250-38 PARCEL SIZE 2.17 <br />OWNER NAME P V <br />CA V1 �y � ' PHONE 2061 05- ) � ! -' <br />OWNER ADDRESS _( (n� �• LLjj.'V�VVIFIS 10 _CITY/STATE/ZIP 1 rGGLi C. <br />CONTRACTOR TERRACON CONSULTANTS INC. /AARON MEJORADO PHONE 209-367-3701 <br />CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY/STATE/ZIP LODI, CA 95240 <br />LICENSE ❑DC -42 F1 1C-36 OTHER PE NUMBER 7244 EXPIRATION DATE 06/30/2022 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST #-3 BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION l REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />J REPLACEMENT J OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE I 1 COMMERCIAL 1_I OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />❑ GREASETRAP <br />❑ LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />❑ PKG TX PLANT <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br />Amount Date <br />Remitted <br /># OF LINES <br />Invoice # <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />❑ FILTER BED <br />WIDTH <br />It LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />It PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LENGTH OF LINES _ <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />It PROPERTY LINE <br />DEPTH <br />It PROPERTY LINE <br />DEPTH <br />It PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />It <br />ft <br />It <br />It <br />ft <br />It <br />It <br />It <br />It <br />ft <br />It <br />It <br />DEPARTMENTU EONLY <br />Application Accepted By G'— !-% Date it 2 2 1 Area`S G61 Employee ID#_A-5 <br />Final Inspection By a Date 0 2- ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pikump Soil Character: <br />COMMENTS <br />PE SC <br />Code INFOB <br />Received Check#/ <br />Cash <br />Amount Date <br />Remitted <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />aaa fa3 <br />ys� <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />