SR0078806 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN rOUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON,9EFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOBADDRESS tgrZ E 4t>�k CITY/ZIP 5 C -F `'ISZ.C'C CROSS STREET �_ __q6 S \Y e c—+ APN I / PARCEL SIZE 1 OWNER NAME _arCo /4-141'L6 17 d 0 PHONE (20 OWNER ADDRESS �5m r' _ CONTRACTOR _ ""TT�� CONTRACTOR ADDRESS LICENSE C-42 C-36 OTHER NUMBER CITY/STATE/ZIP PHONE CITY/STATE/ZIP PF I? jurrinn EXPIRATION DATE f'1 y'n-rim', WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIG ED/ALTERNATI REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION 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_ ❑ LEACH LINES LEACHING CHAMBERS _ CAPACITY CAPACITY ft FOUNDATION ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL Received Check#/ a ft FOUNDATION Permit/ Service Re uest #1 ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH r `DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED TH ft LENGTH ft DEPTH �lvk_j� �I�TANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SOMPS WIDTH ft LENGTH ft DEPTH ARP a DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTi0ANE U ❑ DI'SPOSAL PONDS WIDTH ft LENGTH ft DEPTH 0 FL ":WL'IQUIAI DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY L R1EH MF Nay ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH N&r- DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN .IOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVEITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATT.NAWS. NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL SIGNED -- 1 Application Accepted By 7�p Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS TITLE 0 Cd,' r/ cr� DATEJ,49 D E PA R TM E A/ T�U S4 ONLY Date Area Employee ID# Date ❑ SPE IAL PERMIT - Approved by Pit/Sump Soil Character: ft ft ft ft ft ft ft ft ft ft ft ft PE ode SC INFO Received Check#/ a Amount Remitted Date Permit/ Service Re uest #1 Invoic mit ID# -7 _S7 dt� :k ""_jL1w"j X X 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 J.