SR0084585 - 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-KEFUNDABLE PERMIT GALL (ZU9)�9953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESS ry % y�� /CJ 1]l,t� • j -+C CITY/ZIP CROSS STREET APN 30-733 '� PARCEL SIZE OWNER NAME At /'� �e (f' �l P�/ P \: I K� ) PHONE OWNER ADDRESS Sty. bon CITY/STATE/ZI7P� CONTRACTOR Z�w ��' PHONE CONTRACTOR ADDRESS 2/ % CITY/STATE/ZIP LICENSE ❑''A-42 ❑❑C-36 OTHER NUMBER �SJG 'YS EXPIRATION DATE O WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT tL; N �� j J hf° ❑ OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION f 4j Il k INSTALLATION WILL SERVE: f RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: I &— SEPTIC TANK TYPE/MFG 4�ff L CAPACITY %ZLti gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL Sv ft FOUNDATION % S ft PROPERTY LINE /Gx,' �- ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) & LEACH LINES BLEACHING CHAMBERS DISTANCE TO NEAREST WELL ft FILTER BED WIDTH ft LENGTH # OF LINES LENGTH OF LINES % 5 ft FOUNDATION Szl ft PROPERTY LINE /co � ft ft DEPTH ft ❑ SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft DEPTH ft 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. MINIMUM 48 HOUR ADVANCE NOTICE RE IRED FOR INSPECTIONS//- PLEASE CALL 209 953-7697 SIGNED TITLE DATE Z T DEPARTMENT USE ONLY Application Accepted By / — Date Area __qjel V Employee ID# r Final Inspection By I Z Date l❑ SPECIAL PERMIT -Approved by Character of Soil to Depth 3 Ft: Pit/Sump Soil Character: COMMENTS � 'S�f'i1/! CI)rj l^.vj C>c455 j nSGT * ��.i l �lyrc r L� l l rPc1ci(,f� �j� * Qi sy-S4 ;i , PE Code DISTANCE TO NEAREST WELL ft FOUNDATION Permit/ Service l3equest # ft PROPERTY LINE ft MOUNDED WIDTH s ft LENGTH 2zgU o 3 � 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 DISTANCE TO NEAREST WELL ft DEPTH ft 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. MINIMUM 48 HOUR ADVANCE NOTICE RE IRED FOR INSPECTIONS//- PLEASE CALL 209 953-7697 SIGNED TITLE DATE Z T DEPARTMENT USE ONLY Application Accepted By / — Date Area __qjel V Employee ID# r Final Inspection By I Z Date l❑ SPECIAL PERMIT -Approved by Character of Soil to Depth 3 Ft: Pit/Sump Soil Character: COMMENTS � 'S�f'i1/! CI)rj l^.vj C>c455 j nSGT * ��.i l �lyrc r L� l l rPc1ci(,f� �j� * Qi sy-S4 ;i , PE Code Sc INFO Received By hec Cash Amount Remitted Dat Permit/ Service l3equest # Invoice # Permit ID# to s 2zgU o 3 � i� iI T -V 5 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T