SR0085608 - Laserfiche WebLink

Home Browse Search

I +, ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT SEPTIC TANK GREASE TRAP LIFT STATION GALL ZU9 953-7697 FOR INSPECTIONS tXPIRES 1/YEAR FROM DATE ISSUEI JOB ADDRESS IQ gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE SAND OIL SEPARATOR (ENCL14Q'!/AYiCT�Nj ��►CC// �V D ` yJ CROSS STREET 0(r, �U�S "' 1 I `G / ��7CIITY/ZIP f��% APN l J / 2 `� � 007 / PARCEL SIZE S T OWNER NAME—,Jose �C�� PHONE OWNER ADDRESS /.J�^ ,. e 1 / 2 CITY/STATE/ZIP l �j CONTRACTOR 1 �"' 4l/ V Lll�t�% �%// c // �p PHONE �C' q ^ � / - /Sd0d Q%,c� CONTRACTOR ADDRESS 3 7Yl� T¢_4_eIl1 ) Ae P CITY/STATE/ZIP C 7� LICENSE / -42 ❑CIC -36 OTHER NUMBER J D S^ EXPIRATION DATE Jv .3 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X ❑ PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I_ I ENGINEER DE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION Y INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL❑ OTHER NUMBER OF LIVING UNITS: l NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: TERNATIVE ❑ ❑ ❑ SEPTIC TANK GREASE TRAP LIFT STATION TYPE/MFG / / TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP ft CAPACITY CAPACITY FOUNDATION ❑ PKG TX PLANT ❑ gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE SAND OIL SEPARATOR (ENCL14Q'!/AYiCT�Nj ��►CC// �V D [3 LEACH LINES - LEACHING CHAMBERS # OF LINES A LENGTH OF LINES AU 'b DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE SAU ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ENV, 0 CO *77y DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE TH DEPARr""/1j , ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH / ft LENGGTH1 ft DEPTH �� ft DISTANCE TO NEAREST WELL ft `/ FOUNDATION /O f ft PROPERTY LINE S ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH 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. DEPARTMENT U E ONLY n IA Application Accepted B�y Date Area `� Employee ID# �J / Final Inspection By � ` Date kb ;,/tZ � SPECIAL PERMIT -Approved by /V Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS anc�P.��.vrv++w7F PY -5}1n' lel;(6 l J 0 FQJ );)Ie beGre' n' /C./ s S. e;NGf lelo'Al or fu�ufig 1�PpcJas . PE Code SC INFO Received 4heck#W Amount ate Permit] B — Remitted Service Request # Invoice # Permit ID# � jllo 115 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18