SR0085496 - 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 NON-KEFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE. JOB ADDRESS ;L 2Lc ji), GOfgD RD CITYIZIP 1-0-Dr2/ 952,10 CROSS STREET 1.1.7 )Z APN (_�`� �4� D V J �+ PARCEL SIZE 3. rf OWNER NAME 11R L-, C1 i4A I ')c1'C�1� 'CC /Y °C /�rPIHOONE FM l OWNER ADDRESS C.J t�,� J 7CI CITYISTATEIZIP \''1Ch5 - CONTRACTOR JS, LcJNY, l(LT�{JyIJ St�TC' T-yc PHONE 6f 4(A Z -21 -DIS -7 , L'I r / , {� CONTRACTOR ADDRESS g�77 Y '�' Sc�Ca �`.z eft_ JQ %�17 CrTYISTATE21P MC.G�Lriv �G'�l/ir2 £{ LICENSE NLl42 I/C36 OTHER ;) NUMBER 9z ZY;L ExPIRATIONDATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST #BUILDING PERMIT # Cl LAND USE APPLICATION # TYPE OF WORK: V NEW INSTALLATION REPAIRIADornON ENGINEER DESIGNED IALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL 2 OTHER / NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: ® SEPTIC TANK TYPE/MFG COdC�'Cr(j�p L CAPACITY /20o gal NOFCOMPARTMENTS 2 ❑ GREASE TRAP TYPEIMFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEARESL WELL l00ft FOUNDATION 2 S ft PROPERTY LINE //d ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PL ANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) id LEACH LINES I/ LEACHING CHAMBERS IAWi, FQ 2Y #OFLINESW 4�R LENGTH OF LINES e, 70 ft DISTANCE TO NEAREST WELL 110 R FOUNDATION 3 If ft PROPERTY LINE ❑ FILTER BED WIDTH R LENGTH R DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft DISTANCE To NEA EST WELL ft FOUNDATION R PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH 'i2 ft DEPTH �2 S ft DISTANCE TD NEAREST WELL it FOUNDATION /,90, ft PROPERTY LINE led R 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. D E P A RTMENTUS E ONLY Application Accepted By t-/ Date -7 7 Area y Employee ID#.Fk_ Final Inspection By -;;�eti.c Date SPECIAL PERMIT -Approved by Chander of Soil to Depth of 3 Ft:PIUSump Soil Character: COMMENTS -j J�irTZ Ile-ffe-t' fe�;J)'- Act' &P' e,, it r 414 t'e e A -ir 71 /'-f l2 Z.. PE SC Received ChecM INFO 8 Cash Amount Date PemTlO Invoice # Perrrdt 11ACode Remitted Service Request # 4201 ONSITE WASTEWATER TR TMNi SYSTEM PERMIT 4,14118 ')