SR0084739 - 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-KEFUNUAULL VEE'H-�MIt �. L ALL ZUJ `JDJ-10J/ FUN INSPhGllUNS GAPIHtS I TtAH FHUM (JAIL I,SUt JOB ADDRESS __-4 . R-+ . 9 E. t"t4A-r7AC6-C Q CITY/ZIP `-��aW S'L(.S CROSS STREET C L. Pr R -K, APN I -/ I 1 Z �J PARCEL SIZE I •« OWNER NAME_ LK RA" GR(�IE(Z__ -C • PHONE (5'10) C" =j-r�O�2S OWNER ADDRESS io_y_GOL.A_ NU�IGGT 19A i l.- CRY/STATE21P G4-rT f 1� IZOIR CA 4I`� 3.30 CONTRACTOR_. - -1VE: OAK- 66_!�p,N'�IleZ)f`J'niLNTAL-• PHONE -3b"I-0315, CONTRACTOR ADDRESS TO, w - 0 "O<F ST • CITY/STATE/ZIP . L.OD 1 C^ 9 •-t4fa LICENSE C42 C-36 OTHER C E,(T NUMBER I ( EXPIRATION DATE -4 - 30 - 2Z J WATER TABLE DEPTH: _ It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST iI ,I ' BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE it REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER WELL NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: FOUNDATION _ ❑ SEPTIC TANK TYPE/MFG CAPACITY gal it OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal i OF COMPARTMENTS DISTANCE TO DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE __.. __. _ TYPE OF PUMP„ 13 PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS OF LINES LENGTH OF LINES ft ft PROPERTY LINE ` h DEPTH 1/ ft PROPERTY LINE ft DEPTH f ft PROPERTY LINE ft ft DEPTH f� ft PROPERTY LINE /ft P, DEPTH ENE 4{H ft PROPERTY LINE LT D Tfdr _fl DEPTH I P:.r]PFRTY I INF (f 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 NOTICE REQUIREDFOR INSPECTIONS - PLEASE SIGNED TITLE ?XD.J . M Ay IR - DATE O -- -- -- - -------- ---- -- --'- --"" - ---- "r © O O ra 01 Application Accepted Final Inspection By_ Character of Soil to D COMMENTS of 3 4 ® 1 I 'A RTMENT U NLY / C Date 7Aea ` C I Employee IDiiL/� _ Date 1 2l 2 SPECT PERMIT - Approved by Pit/Sump Soil Character: PE Sc Received h Amount PermiU Code INFO Remitted a Service Request x Invoice Y Permit IDA 0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118 .SVP^ �i CpUN T' 7 MtAL h'T DISTANCE TO NEAREST WELL ft FOUNDATION_ ❑ FILTER BED WIDTH it LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION _ ❑ MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION _ ❑ SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION _ ❑ DISPOSALPONDS WIDTH ft LENGTH DISTANCE To NEAREST WELL ft FOUNDATION ❑ SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ` h DEPTH 1/ ft PROPERTY LINE ft DEPTH f ft PROPERTY LINE ft ft DEPTH f� ft PROPERTY LINE /ft P, DEPTH ENE 4{H ft PROPERTY LINE LT D Tfdr _fl DEPTH I P:.r]PFRTY I INF (f 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 NOTICE REQUIREDFOR INSPECTIONS - PLEASE SIGNED TITLE ?XD.J . M Ay IR - DATE O -- -- -- - -------- ---- -- --'- --"" - ---- "r © O O ra 01 Application Accepted Final Inspection By_ Character of Soil to D COMMENTS of 3 4 ® 1 I 'A RTMENT U NLY / C Date 7Aea ` C I Employee IDiiL/� _ Date 1 2l 2 SPECT PERMIT - Approved by Pit/Sump Soil Character: PE Sc Received h Amount PermiU Code INFO Remitted a Service Request x Invoice Y Permit IDA 0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118 .SVP^ �i CpUN T' 7 MtAL h'T