SR0084241 - 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 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS C L)�IL/ �- f-Iwy I Z L t2 13 � 2- V CROSS STREET �/ GTo 2 ( /CITY/ZIP Q APN © > t _[ 7� PARCEL SIZE // ` 0 /�� OWNER NAME PA U 6/. / I r L %, �'! PHONE Cas OWNER ADDRESS 2-�( f JGT, 7 I�-j �� CITY/STATE/ZIP // `AN r� C� CA �S / CONTRACTOR EL�L/A'Te() .A 0 E_ye .L c� 0Vq&A r Car) sTrc/c�`��h PHONE 26 1 S -G ft A CONTRACTOR ADDRESS ` � Ly j U 1-J- 13 �r� m Af/ f/ CITY/STATE/ZIP r C"/ CA 4 r 3 1 / LICENSE ❑❑C-42 ❑CIC -36 OTHER NUMBER )UZ �� Z `EXPIRATION DATE /Z' �A / / o / 2 WIDTH ft WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION X, REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -0F -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: X RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 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 gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I 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. SIG DATE DEPARTMENT -US ONLY Application Accepted ByL'e' lf'��/lL—% Date Area Employee ID# Final Inspection Bye��g(o Ills-,o�f� Date 7,12 Z7js,Z2 ❑ SPEC AL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Ttl-r. -Tc P00L-- 4 d& n1 7- 'I" - F-69- u2y/'V2Z PE SC Received Check#/ Amount ate Permit/ Invoice # ❑ LEACH LINES ❑ LEACHING CHAMBERS B Cas # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY INE ft ❑ SUMPS WIDTH ft LENGTH ll SDE H 1G�IRO ft DISTANCE TO NEAREST WELL ft FOU ATI y� 11 ft RTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LEr{�I� L•JJ �� Ill I��I��p ft DISTANCE TO NEAREST WELL `` ft FOUNDATION ft PROPERTY LINE ft (3SEEPAGE PITS NUMBER // WIDTH �) li ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I 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. SIG DATE DEPARTMENT -US ONLY Application Accepted ByL'e' lf'��/lL—% Date Area Employee ID# Final Inspection Bye��g(o Ills-,o�f� Date 7,12 Z7js,Z2 ❑ SPEC AL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Ttl-r. -Tc P00L-- 4 d& n1 7- 'I" - F-69- u2y/'V2Z PE SC Received Check#/ Amount ate Permit/ Invoice # Permit ID# Code INFO B Cas Remitted Service Request # Li4 4OJW--_� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14//14/ 18