SR0085601 - 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 NUN-KEFUNDABLE PERMIT JOB ADDRESS CROSS STREET GALL (LU9) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI CITY/ZIP .5 % r- k-r"l Car C APN X11303 a PARCEL SIZE o9 OWNER NAME 0-3 AyiceA@ d'i L f 1cG 0SYol do J,4 Ure4 u + P/HO^N-E�jJo t OWNER ADDRESS //t� � Sg iI f e- , � o (I�� CITY/STATE/ZIP x726 I ' mA q J Sa r_ CONTRACTOR <.J�N� �' I� V a 1 " % J�� (f /' ,�J PHONE �0q C- 36- r b � 7 *� CONTRACTOR ADDRESS 3 / T k "t. ! I—e r//// CITY/STATE/ZIP cSIOC LICENSE ❑ I -42 ❑ I ':C-36 OTHER NUMBER T T907 EXPIRATION DATE ) ob-3 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: ❑ NEW INSTALLATION I lel Ei REPAIR/ADI Coordinates X Y LAND USE APPLICATION # iN `C_ ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT tAnk I tie -0 k OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION LAVtK INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL NUMBER OF LIVING UNITS: SEPTIC TANK ❑ GREASETRAP ❑ LIFT STATION NUMBER OF BEDROOMS: ❑ OTHER NUMBER OF EMPLOYEES: TYPE/MFG Co, -La /�i C CAPACITY 61? v gal # OF COMPARTMENTS TYPE/MFG CAPACITY gal # OF COMPARTMENTS � � T DISTANCE TO NEAREST: WELL IOC ft FOUNDATION %® ft PROPERTY LINE �0 ft 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. MINIMUM 48 HOUR ADVANCE NO CE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-76997401 SIGNED Z352CTITLE DATE -/ ^ oma{ 'vsK / DEPARTMENT US& ONLY / Application Accepted B `� Date -7 �9 ,Wa Area +1 Employee ID# AG Final Inspection By Date Z (/1 &7 &0Z7 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft:Pit/Sump Soil Character: COMMENTS Unde4,CrrrtineG_ f Ti'Gr _ 5X1S1lnti iineS }� be a%�n�onec/ pDrol ise15 o (we cor?Ciwecl 5fUlus /U -'AiQj c Ari PE Code LEACH LINES L! LEACHING CHAMBERS # OF LINES ft PROPERTY LINE �Sr ft DEPTH 00 ft PROPERTY LINE ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft ❑ FILTER BED WIDTH ft LENGTH ft PROPERTY LINE ft ft DEPTH V ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ MOUNDED WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SUMPS WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DISTANCE TON ARES WELL ft FOUNDATION SEEPAGE PITS NUMBER WIDTH 3& 1" DISTANCE TO REST i WELL ft FOUNDATION 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 HOUR ADVANCE NO CE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-76997401 SIGNED Z352CTITLE DATE -/ ^ oma{ 'vsK / DEPARTMENT US& ONLY / Application Accepted B `� Date -7 �9 ,Wa Area +1 Employee ID# AG Final Inspection By Date Z (/1 &7 &0Z7 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft:Pit/Sump Soil Character: COMMENTS Unde4,CrrrtineG_ f Ti'Gr _ 5X1S1lnti iineS }� be a%�n�onec/ pDrol ise15 o (we cor?Ciwecl 5fUlus /U -'AiQj c Ari PE Code SC INFO LENGTH OF LINES 5, ft ft PROPERTY LINE �Sr ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft ft DEPTH V ft ft PROPERTY LINE /Q 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 HOUR ADVANCE NO CE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-76997401 SIGNED Z352CTITLE DATE -/ ^ oma{ 'vsK / DEPARTMENT US& ONLY / Application Accepted B `� Date -7 �9 ,Wa Area +1 Employee ID# AG Final Inspection By Date Z (/1 &7 &0Z7 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft:Pit/Sump Soil Character: COMMENTS Unde4,CrrrtineG_ f Ti'Gr _ 5X1S1lnti iineS }� be a%�n�onec/ pDrol ise15 o (we cor?Ciwecl 5fUlus /U -'AiQj c Ari PE Code SC INFO Received By Check#/ Cash Amount Date Remitted Permit/ Service Request # Invoice # Permit ID# ga16 IIs % OR -.211L DONS(Vo 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T