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SR0084857
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0084857
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Entry Properties
Last modified
3/4/2022 4:09:44 PM
Creation date
3/4/2022 2:58:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0084857
PE
4221
FACILITY_NAME
9851 E MARIPOSA RD
STREET_NUMBER
9851
Direction
E
STREET_NAME
MARIPOSA
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
18109003
ENTERED_DATE
2/11/2022 12:00:00 AM
SITE_LOCATION
9851 E MARIPOSA RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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�w • <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 F94 INSPECTION EXPI 1 YEAR FROM DATE ISSUE <br />JOB ADDRESS/Ld'n120S q_ IP <br />L <br />�A;S <br />CROSS STREET pLl' 0JAVU S APN % PARCEL SIZE t <br />OWNER NAME t \ i� 1 V 1 l C ``C / D n, ( I(QN� `y im PHONE <br />OWNER ADDRESS �,� (� CITY/STATE/ZIP % <br />CONTRACTOR Y V/�- r PHONE <br />CONTRACTOR ADDRESS r 6� La CITY/STATE/ZIP t�S<ct U l <br />LICENSE ❑LIC -42 [10C-36 OTHER NUMBER �w� EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: F]NEW INSTALLATION [I REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />Ll REPLACEMENT 11 OUT -OF -SERVICE SEPTIC SYSTEM ❑DESTRUCTION (t L <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />CAPACITY <br />CAPACITY <br />DISTANCE TO NEAREST: WELL ft FOUNDATION _ <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT <br />D <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />FJ LEACHING CHAMBERS <br />Received <br />By <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />Permit/ <br />Service Request # <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH ft LENGTH <br />•I� Zz <br />n <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />1,/� <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LIN n <br />ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY A01 11A, <br />ft <br />❑ DISPOSAL PONDS <br />WIDTH ft LENGTH <br />ft DEPTHHFALTu D/VINFNZ4 7Y <br />ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE �TMENT <br />ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />_----S-TATE LAWS AND RULES AND <br />REGULATIONS <br />OF SAN JOAQUIN COUNTY. <br />SIGNED <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS 90- u _ C. 29 S --P <br />1. (_ A -\-s7o& D <br />twVo - &Vv w.. . v <br />I! a C �' �� DATE <br />DateArea <br />— <br />t�� <br />Date o ❑ SPE <br />Pit/Sump Soil Character: <br />�g Employee ID# <br />AL PERMIT -Approved by <br />42-01 C l 3 l I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />Sc <br />INFO <br />Received <br />By <br />Ch <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />PE <br />Code <br />ZZ <br />� <br />•I� Zz <br />Sp.���I 85 <br />42-01 C l 3 l I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />
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