SR0082769 - 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—REFUNDABLE PERMIT CALL 209 9n533--7697 FOR INSPECTIONS d, A - EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS ZS�(O ( Ar . FV �YVI 19C IV I—•— —CITY/ZIP 14'C M PD 3' X LD CROSS STREET COLL,(er— APN pZl —via `S9 -PARCELSIZE q k &&- OWNER NAME PC&I4W pg -0 - 0&U M &4 PHONE—3 21 - !;3S p OWNER ADDRESSCITY/STATE/ZIP CONTRACTOR %X L)p.�e— &e7Cw^!Vke6/Jw1V1jTL PHONE J(Dy - J -) 5" CONTRACTOR ADDRESS AO W. 0,111I •ST • CITY/STATE/ZIP L 0i'> (•� GA r7 S' 2-Y0 LICENSE 000-42 OCC -36 OTHER CECT NUMBER 2-15-1 EXPIRATION DATE 4+ - 30 "'ZZ - WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y I.!,< PERC TEST # ( BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ._. NEW INSTALLATION U REPAIR/ADDITION D ENGINEER DESIGNED/ALTERNATIVE .... REPLACEMENT I:.I OUT -OF -SERVICE SEPTIC SYSTEM 0 DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG ❑ GREASE TRAP TYPEIMFG CAPACITY 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) ❑ LEACH LINES i:7 LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft Permit/ DISTANCE TO NEAREST __ ft FOUNDATION ft PROPERTY LINE ftl ElFILTER BED WIDTH ft L IGT. ft DEPTH sa DISTANCE TO NEAREST _ ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft GTH ~ ft DEPTH y DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY LINE ❑ SUMPS WIDTH ft LENGT ft DEPTH S!�/)J it DISTANCE TO NEAREST WELL DATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft .1 HERESY 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 R ADM= NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 09 953-7697 SIGNED ___ TITLE 42G)• mGQ DATE e- UA 2-0 / DEPARTMENT USE ONL Y aq 7� Application Accepted L Date 8 d7 u2Ja� Area y f�Employee ID# DA Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 t: Pit/Sump Sor'I Character: COMMENTS S�L.4160 A/ - t1 P : wj i4e) PE SC Received QhaqW Amount Permit/ Code INFO Date ash Remitted Invoice# PermitlD# Service Request # yaaa sa ►s z -� y 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 !IN Y rM ti77A. 7