SR0085567 - 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 PERMIT CALL 209 )953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED CITY/ZIP JOB ADDRESS n CROSS STREET�ZE4�/J APN Dg 3 9 go da PARCELSIZE OWNER NAME' 4 //y.�rD� % i PHONE zl LCz A� moi/ ei✓.s�!/ G %tSl s�(� OWNER ADDRESS .�`.C�l/ � r CITY/STATE/ZIP CONTRACTOR f _ - PHONE CONTRACTOR ADDRESS �1 jam,_ s' CITY/STATE/ZIP LICENSE ❑ C-42 ❑ C-36 OTHER NUMBER 2 z EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y Received By ❑ PERC TEST # BUILDING PERMIT # D)0 0 LAND USE APPLICATION # Date TYPE OF WORK: /j NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE Permit ID# at1 REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION WILL SERVE: R SIDENCE ❑ COMMERCIAL ❑ OTHER 6aq LINSTALLATION >> NUMBER OF LIVING UNITS: OF BEDROOMS: / NUMBER OF EMPLOYEES: SEPTIC TANK /NUMBER TYPE/MFG C CAPACITY / ��L9 gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # LINES LENGTH OF LINES �� ft LEACH LINES LEACHING CHAMBERS OF .moi DISTANCE TO NEAREST WELL0 --r ft FOUNDATION A2n!-! ft PROPERTY LINE � � ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY NE ft SEEPAGE PITS NUMBER WIDTH "��4 // ft DEPTH 11111S ft DISTANCE TO NEAREST WELL/ {j/hl j- ft FOUNDATION /�� ft PROPERTY LINE s 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. Ml UM 48 H01JR ADV NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 `-) SIGNE /1 TITLE / G DATE ` DEPARTMENT USE ONLY Application AcceptedB Z., /--Date 7a as Area Employee ID# Final Inspection By � "C' I(CAIVy „ h f Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS SeGonGl (Jn,r D'4e11101ref � lJor- ►epa(r� ref � lJor- ►epa( PE Code Sc INFO Received By Che Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# at1 117 Z05 6aq -22.22 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18