SR0079668 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P 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 YEAR FROM DATE ISSUEI JOB ADDRESS '�+ �b SteA %Zkl z- Ave, _/CIITYA`IIP CROSS STREET ClT-e / rVV �-j+- 0 APN , 0�7� V �/ `� r PARCEL SIZE IQ.l/ OWNER NAME 0"&f t:_!c �l 11�L�-LF¢bY- PHONE w! --I1-) 1'2-y4 4 OWNER ADDRESS l/� �� -CITY/STATE/ZIP CONTRACTOR C_ PHONE CONTRACTOR ADDRESS CITY/STATE2IP LICENSE I C-42 I I C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION PAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE LI COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG 1P%41 CAPACITY ❑ GREASE TRAP TYPE/MFG 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) I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATTON LAWS. MIM M H R ADZdKF,-WTJeE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED i 4,_ TITLE �Nf V- DATE ZG Application Accepted By Final Inspection By Character of Soil to Dept COMMENTS S` l 4 Boa Rti i d v z TMENTIJSEDNLY Hale_ Aiea Elilploye6lU4_ Date ❑ SPECIAL PER IT - Approved by Pit/Sump Soil Character: M CM PE ode LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES 17Q 1 ft ate Service Request # DISTANCE TO NEAREST WELL I�Z ft FOUNDATION 16 ft PROPERTY LINE S(� ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH ft LENGTH 114 ft DEPTH 9 r ft DISTANCE TO NEAREST WELL 4� I ft FOUNDATION 10 ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATTON LAWS. MIM M H R ADZdKF,-WTJeE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED i 4,_ TITLE �Nf V- DATE ZG Application Accepted By Final Inspection By Character of Soil to Dept COMMENTS S` l 4 Boa Rti i d v z TMENTIJSEDNLY Hale_ Aiea Elilploye6lU4_ Date ❑ SPECIAL PER IT - Approved by Pit/Sump Soil Character: M CM PE ode SC INFO Received Check#/ Ca AmountPermiU emitted ate Service Request # Invoice # Permit ID# (� 20 15a• GI � �� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 s