SR0085064 - 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 3VL / /.7 q y« CITY/ZIP Sloe e*t 4 r cT "Il) G) 7 CROSS STREET ' �I '/(—ac / � Cou- APN O I 1*)Ik PARCEL SIZE OWNER NAME IJu✓dY vi P f 0 PHONE JWNER ADDRESS CITY/STATE/ZIP CONTRACTOR / z PHONE (7q CONTRACTOR ADDRESS CITY/STATE/ZIP U / �jfes✓ �/— _��1 GS azI G LICENSE ❑IyC-42 ❑iIIC-36 OTHER NUMBER C� 0 EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION #_ TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESK REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION _ INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: TERNATIVE ❑ SEPTIC TANK TYPE/MFG "i �I "� �I CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS FOUNDATION c� ft PROPERTY LINE 0`C% ft DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ 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. SIGNED Application Accepted By � Final Inspection Bye Character of Soil to Depth of COMMENTS Date Date vr[ n�.�rc�.►/v/v� - r«r+.�� a./�� Awa/ JJJ-/ Vim/ TITLE DATE L2 — USE ONLY Area `� ( Employee IDA ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: G - lZ(, Z44 PE Code LINES LEACHING CHAMBERS �� # OF LINES LENGTH OF LINES_ ft exLEACH 11� 2�6 DISTANCE TO NEAREST WELL ft FOUNDATION c� ft PROPERTY LINE 0`C% 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 LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL �ycCCJ � ftt/ FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER q WI�bf'_ Ab " ft DEPTH gs / ft DISTANCE TON REST WELL C ft ,A FOUNDATION 19G ! ft PROPERTY LINEyW 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. SIGNED Application Accepted By � Final Inspection Bye Character of Soil to Depth of COMMENTS Date Date vr[ n�.�rc�.►/v/v� - r«r+.�� a./�� Awa/ JJJ-/ Vim/ TITLE DATE L2 — USE ONLY Area `� ( Employee IDA ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: G - lZ(, Z44 PE Code SC Received heck Amount INFO Remitted Date Permit/ Invoice # Permit ID# Service Request # 2(L- 11� 2�6 -21�00� 5 0L-1 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18