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SR0084871
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4200/4300 - Liquid Waste/Water Well Permits
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SR0084871
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Entry Properties
Last modified
3/4/2022 4:10:01 PM
Creation date
3/4/2022 2:59:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0084871
PE
4210
STREET_NUMBER
8796
Direction
W
STREET_NAME
FELIZ
STREET_TYPE
WAY
City
TRACY
Zip
95304
APN
24811012
ENTERED_DATE
2/15/2022 12:00:00 AM
SITE_LOCATION
8796 W FELIZ WAY
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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Tags
EHD - Public
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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 <br />(:ALL ZUyJ Y03 -/by/ FOR INSPECTIONS <br />tXPIKLS� -1 TEAK I-KUM UAI t 155Ut1 <br />1 ( <br />JOB ADDRESS (/% <br />� 1 <br />I/ - x/1%4/-"/ <br />1 `t%- � <br />^ <br />CITY/ZIP �1 -.G! G <br />CROSS STREET a"- 1, <br />r'All- APN <br />d ^^ He lb (a <br />PARCELSIZE <br />ft <br />❑ FILTER BED <br />WIDTH <br />ft LEN TH <br />OWNER NAME IS' ` L. C[ <br />✓� S4V KdG <br />M(J It <br />PHONE <br />OWNER ADDRESS ��� �a. <br />61tic/`t11 d � <br />CITY/STATE/ZIP <br />35yn' r.+-)(. C.4 Q� <br />CONTRACTOR W (` & � <br />A Cac(+O -C- <br />PHONE/,�L'���c <br />ft LENGTH <br />CONTRACTOR ADDRESS <br />`� <br />CITY/STATE/ZIP <br />, <br />(/� L� G/T 7J (o <br />�S <br />LICENSE ❑DC -42 ❑LDC -36 <br />OTHER NUMBER <br />EXPIRATION DATE <br />9 <br />�[l� <br />❑ PERC TEST # BUILDING PERMIT # <br />TYPE OF WORK: 0 NEW INSTALLATION <br />D REPLACEMENT a <br />/ LAND USE APPLICATION #_ <br />REPAIR/ADDITION ❑ ENGINEER DE <br />OUT -OF -SERVICE SEPTIC SYSTEM [I DESTRUCTION <br />V <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL r ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: © 3 O:1 NUMBER OF EMPLOYEES: <br />} id SYS M <br />U 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 />SERNATIVE <br />gal if Ur UUMF'AK I MtN I J <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />EACH LINES <br />❑ LEACHING CHAMBERS <br />Received <br />Bv <br /># OF LINES �_ LENGTH OF LINES `[a' <br />ft <br />Date <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE '51 <br />ft <br />❑ FILTER BED <br />WIDTH <br />ft LEN TH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />SUMPS <br />WIDTH ; , <br />ft LENGTH <br />'a , <br />ft DEPTH Q ( <br />ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION %<% ft PROPERTY LINE S <br />ft <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED <br />TITLE �eLI�C[�D� DATE <br />DEPARTMENT U E ONLY C/ A� <br />Application Accepted By `-- 1� Date /S o? Area 5 / Employee ID# <br />Final Inspection By Date Z� ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Unkv),)wy) ley �,Ja .s, Lf 5 5i✓T� Se'V"e <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />42-01 <br />4/14/18 <br />SC <br />INFO <br />Received <br />Bv <br />#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Req est # <br />Invoice # <br />Permit ID# <br />PE <br />Code <br />L <br />)ice <br />0s� <br />1. <br />v$` <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />42-01 <br />4/14/18 <br />
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