SR0085839 - 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-REFUNDABLE PEERMIT c CALL(209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED Joe ADDRESS 7 D O 1,2 ,�� •� !`0)U R I tt d- C (C'ITYIZIP (�D�C IL.1 -/S J.0 C q r7 q V" CROSS STREET t 1C;IG r1! L!WIC APN `J `� PARCEL SIZE Or.0 / p OWNER NAME V(QG/Y)) f c(des � e Sn PHONE �-�c9�S'I�I -��17 OWNER ADDRESS 7''S O CI D'1VV SC!h Ll I It, R6• r,c, CITY/STATEIZIP f �f�� CONTRACTOR r Y Jff Ni f f-r f`Cr�1�`�bU C `+) PHONE •�V l_" /l CONTRACTOR ADDRESS P. V ' OC K. Lf 1' 'VjC t Q I`,mnfp' (-hI/CITYISTATE/ZIP 1, C/S� 14 S LICENSE ❑ C-42 ❑ C-36 OTHER &3 IA NUMBER �o 4'�EXPIRATION DATE WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# D LAND USE APPLICATION# TYPE OF WORK: ]. NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: xS RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ) NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG __ CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS DISTANCE O NEAREST: WELL ft FOUNDATION fl PROPERTY LINE ft P LIFT STATIONIZE 1 NP TYPE OF PUMP ✓0F1 O ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) P, a3(s�il- ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES it DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it ❑ FILTER BED WIDTH it LENGTH It DEPTH fl DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL fl FOUNDATION_ fl PROPERTY LINE ft �[. SUMPS WIDTH_ It LENGTH ft DEPTH _ it DISTANCE TO NEAREST WELL_ R FOUNDATION_ ft PROPERTYLINE_ ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE 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. MINIMUM$k HOURLADYANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 99r�53-716977 SIGNED w TITLE 0,�lneY DATE�1 Li v/ V1 SR. r ! a Q N T DEP R NT.USE ONLY [7 ENT Application Accepted By — –�z G Date 1 .Z Area •S / Employee ID# AS Final Inspection By V Date Q Z ❑ SPECIAL PERMIT-Approved by Character of Soil to Dept of 3 Ft: it/Sump Soil Character: COMMENTS Acklihan J0 of hf't StA, Iakt s fIc sy54eni. R• A1,n'r AIr 1,'Or SFR , wnlyC{ Issve {:Dr r o , <"4eN9. oylfz c'oIIY1P,CfID11 row SPp?/c -t-o r/e,j St�cc•�v/P ,, PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service Request# ya�� I(s 31a •2q•22 S p g3°I 42-01 C I JO�(,If�IX ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18