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SR0085077
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0085077
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Entry Properties
Last modified
5/25/2022 3:13:37 PM
Creation date
5/25/2022 2:36:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0085077
PE
4210
STREET_NUMBER
30000
Direction
S
STREET_NAME
KASSON
STREET_TYPE
RD
City
TRACY
Zip
95304
APN
24115001
ENTERED_DATE
3/30/2022 12:00:00 AM
SITE_LOCATION
30000 S KASSON RD
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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Tags
EHD - Public
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LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br />DISTANCE TO NEAREST WELL <br />DISPOSAL PONDS WIDTH <br />SEEPAGE PITS <br />Ei LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION - r ft PROPERTY Ll7E ft <br />WIDTH 3c l , <br /> <br />ft LENGTH ---0 ft DEPTH / ft <br />DISTANCE TO NEAREST WELL IJ A ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH ft LENGTH ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />NUMBER <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 <br /> C LL (209) 953-767 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />irDd ZAsso.Q (C,lit 1 :SS311iIIIV 3IIS JOB ADDRESS <br />CROSS STREET 4/‹.)6--6Y1 j SOfh et <br />OWNER NAME 41O/& I/ <br />OWNER ADDRESS A <br />(2-tX21 11 3 Cry <br />CIO 6v <br /> CITY/ZIP / e <br />PARCEL SIZE <br />PHONE 6'eq-54/1—S-3D <br />CITY/STATE/ZIP <br />PHONE 070(7-4-3g-52A-6 <br />CITY/STATE/ZIP fnOd Fro qS-31 <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />APN CRMS ) <br />ki 4 zuc <br />LICENSE 00C-42 C-36 OTHER NUMBER /0 70 b, tit EXPIRATION DATE <br />WATER TABLE DEPTH: 10 dO ft GEOGRAPHICAL INFORMATION: Coordinates X <br />0 PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: E NEW INSTALLATION 0REPAIR/ADDITION <br />REPLACEMENT tt;HIr. el d 0 OUT-OF-SERVICE SEPTIC SYSTEM <br />0 ENGINEER DESIGNED /ALTERNATRIE <br />DESTRUCTION 5rpt )4 1-6,;14 k <br /> <br />INSTALLATION WILL SERVE: <br /> E RESIDENCE <br /> <br />X COMMERCIAL <br /> <br />C OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 71:2 <br />SEPTIC TANK <br />GREASE TRAP <br />TYPE/MFG P <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL r 1 <br />CAPACITY /c)t) gal <br />CAPACITY gal <br />ft FOUNDATION /0 ft <br /># OF COMPARTMENTS <br /># OF COMPARTMENTS <br />PROPERTY LINE ft <br />LIFT STATION <br /> <br />SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />TATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINI M OUR DV NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE ./?/1447LY DATE <br />111.. lii <br />DEPARTMENT US ONLY <br />Application Accepted By Date 3/3 (-22 Area Employee ID# <br />Final Inspection By A , Date (7,7_, 0 SPECIAL PERMIT -Approved by <br />COMMENTS UnCif +e/ YvIolf 'Tier gets.cicw.)-ervi tf anCi tet ,ch fle)d /n611)1600 /51-;f6Ck <br />Character of Soil to Depth of 3 Ft: Pi Sump Soil Character: <br /> <br />(loY0 fjoCil 1-0 .57) ic folk ciha GO 1-0 f;e1c1 wI 4, e 01,i ver or or Farkedop. <br />1,e4ck (;eld to be c ovci,ed or co-ncitq-e <br />PE <br />Code <br />SC <br />INFo <br />Received <br />By <br />Check#/ <br />Cas ., <br />i <br />Amount <br />Remitted ate Permit/ <br />4prvi,ce‘Bequest # Invoice # Permit ID# <br />i-P I 0 1)1- d7S-- *?DC) % o\ 50011'a-71' <br />42-01 <br />4/14/18 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT
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