SR0077633 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SA" JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT G L ZU`.i y5J-/b5/ FOR INSPECTIONS I T tAH I -HUM WA It I55UtL JOB ADDRESS jj r CITY/ZIP r1' /r-XNIHt5 / LG LAND USE APPLICATION # r r y � U NEW INSTALLATION REPAIR/ADDITION CROSS STREET C C' PN ! PARCELSIZE+ �5 OUT -OF -SERVICE SEPTIC SYSTEM +V" INSTALLATION WILL SERVE: RESIDENCE OWNER NAME k ❑ OTHER PHONE 1 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: / ❑ SEPTIC TANK l OWNER ADDRESS 0 V CITY/STATE/ZIP l ❑ GREASE TRAP CONTRACTOR PHONE gal # OF COMPARTMENTS CONTRACTOR ADDRESS CITY/STATE/ZIP ft FOUNDATION It PROPERTY LINE LICENSE I C-42 L! C-36 OTHER NUMBER EXPIRATION WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y Amount Remitted I 1 PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTIONC INSTALLATION WILL SERVE: RESIDENCE I COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (EN SQg *STEM) ❑ LEAC CHING CHAMBERS -_191 # OF LINES LENGTH OF LINES ft NCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It ❑ D WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 SIGNED �`'l� { [-� TITLE I �� (' -i /953-7697 DATE Application Accepted BY-� Final Inspection By Character of Soil to Depth of 3 COMMENTS N\141 c N T DEPARTMENT U E 9NLY J Date_ � /= Area / Employee ID# t' �• Z Date I 1 SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE Code Sc Received INFO By Check#/ Cash Amount Remitted Date Permit/ Service Request # In 'ce # Permit ID# i...c a.& 4'Mu" 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12