SR0085407 - Laserfiche WebLink

Home Browse Search

1 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 U z� 1 CITY/ZIP '1 CROSS STREET �/ a AP 45715 - (03 - 0-!;- PARCEL SIZE U - OWNER OWNER ADDRESS CITY/STATE/ZIP PHONE CONTRACTOR zl'� ler '--j PHONE 2- CONTRACTOR CONTRACTOR ADDRESS / �J L/ 'C ✓ / CITY/STATE/ZIPy�- LICENSE ❑LIC -42 ❑ C-36 OTHER / ' NUMBER �/ yf j EXPIRATION DATE -';11_7J1 I WATER TABLE DEPTH: -70 ft GEOGRAPHICAL INFORMATION ❑ PERC TEST # BUILDING PERMIT # C TYPE OF WORK: NEW INSTALLATION 0 R PAIR/ADI Coordinates X Y LAND USE APPLICATION # REPLACEMENT i OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION D /ALTERNATIVE INSTALLATION WILL SERVE: ® RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: �4 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS Amount emitted ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS Permit ID# DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # 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 DISTANCF 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 ft FOUNDATION ft PROPERTY LINE ft 0 SEEPAGE PITS NUMBER - 'L_ WIDTH ft DEPTH Z>"— ft DISTANCE TO NEAREST WELL /S�O 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. MINIMUM 48 ; OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE GJ,�i �/�c�Ji- DATE 6/ / Q .Xo Z2 EPARTME TUS ONLY Application Accepted By Date ,// 2 Area � Employee ID#_ Final Inspection By Date li` ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS 6,'VVA - /6�./ _ �-�� , ()A)` C-_rf4 I1X-SV - PE Code Sc INFO Received B heck# Amount emitted ate Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T