SR0084681 - 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 NUN-KEhUNUAt3LEQQPER`'MIT L ALL LUY) YDJ-/UJ/ FOR INSPECTIONS LXPIRES l YEAR FROM UATE ISSUEI r JOB ADDRESS U G S''r ,e 2 CITY/ZIP LAN ri,9-2 3 6 CROSS STREET 1S APN ✓ / J /S PARCEL SIZE `,' J-3 OWNER NAME k__N *_ 6&t-- 'tom PHONE -7 04 — /+Oct �- Q 130 OWNER ADDRESS S3 S. �-IC—Zt7 Iii 1I (G CITY/STATE/ZIP LL }->>10E�i ( G % S-43 CONTRACTOR D W f J I_—YL PHONE 2 6 O CONTRACTOR ADDRESS LICENSE ❑0C-42 DEC -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 Ll REPAIR/ADDITION I7 ENGINEER DESIGNED / LTERNATIVE ❑ REPLACEMENT J OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTIO G INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG CAPACITY CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION _ ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ LEACH LINES ❑ LEACHING CHAMBERS DISTANCE TO NEAREST WEL ❑ FILTER BED WIDTH ft DISTANCE TO NEAREST WELL L1 MOUNDED WIDTH ft DISTANCE TO NEAREST WELL ❑ SUMPS WIDTH ft DISTANCE TO NEAREST WELL ❑ DISPOSAL PONDS WIDTH ft DISTANCE TO NEAREST WEL ❑ SEEPAGE PITS NUMBER DISTANCE TO NEAREST WELL gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft Ll SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES LENGTH OF LINES L ft FOUNDATION LENGTH ft ft FOUNDATION LENGTH ft ft FOUNDATION LENGTH ft ft FOUNDATION LENGTH ft L ft FOUNDATION WIDTH ft FOUNDATION ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE T 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. SIGNED 1 ✓ -. /r -LAZA— TITLE DATE '! DEPARTMENTaSV ONLY Application Accepted By Date y Area ! / Employee ID# Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pi Sump Soil Character: COMMENTS 46 C'2t��iC- a-,-, /- C 7 A-1 ft ft ft ft ft ft ft ft ft ft ft ft PE Sc Received Check#/ AmountPermit/ Code INFO By ash Remitted Da Service R que t Invoice # Permit ID# '122/ 01-5, S 42-01 �J 1 �(O��s/ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE T 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. SIGNED 1 ✓ -. /r -LAZA— TITLE DATE '! DEPARTMENTaSV ONLY Application Accepted By Date y Area ! / Employee ID# Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pi Sump Soil Character: COMMENTS 46 C'2t��iC- a-,-, /- C 7 A-1 ft ft ft ft ft ft ft ft ft ft ft ft PE Sc Received Check#/ AmountPermit/ Code INFO By ash Remitted Da Service R que t Invoice # Permit ID# '122/ 01-5, S 42-01 �J 1 �(O��s/ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T 42-01 �J 1 �(O��s/ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T