Laserfiche WebLink
0 <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 CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 26500 HOLY Dr, CRYfZJP T.'. ca ft -'j. <br />CROSS STREET W' Sugar R -d <br />OWNER NAME Holly 1;.—., o Center, LLC <br />OWNER ADDRESS 2: L"layette Gree, S,Ite 200 <br />lL 4 <br />'04JICONTRACTOR F"timer Cma[n 'f <br />APN 212-100-200 <br />PARCEL SIZE "'- <br />PHONE 925-283-5777 <br />Leteyeve CA 94549 <br />909.947.9487 <br />/.CLf CONTRACTOR ADDRESS t725sc— T, CITY/STATEZP O"ra"°•C"T—ia917e1 <br />LICENSE 011C-42 ❑❑C36 OTHERS NUMBER (1114 EXPIRATION DATE 0712943 <br />WATER TABLE DEPTH: e ft GEOGRAPHICAL INFORMATION: Coordinates X 37.769291 Y -121.422378 <br />❑ PERC TEST # BUILDING PERMIT# Gopptl116 LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPA[R/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT 7 OUT -OF -SERVICE SEPTIC SYSTEM Cli DESTRUCTION Septic Removal <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPFIMFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TD NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <br />❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) r <br />C,7 LEACH LINES r LEACHING CHAMBERS # OF LINES LENGTH OF LINES <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE,1� <br />❑ MOUNDED WIDTH ft LENGTH ft DEPTH A, 'Ytryry44 <br />DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINEr�1ftt <br />❑ SUMPS WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELLft FOUNDATION It PROPERTY LINE A <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br />❑ SEEPAGE PITS NumeER WIDTH ft DEPTH ft <br />DISTANCE TC NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED %Ki a CY[ a TITLE Government Liaison DATE 05173/2022 <br />—w— I v <br />