SR0050904 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"D FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT..-- r CALL(209)953-7697 FOR INSPECTIONS - EXPIRES 1 YEAR FROM DATE ISSUED LA JOB ADDRESS C u Q ` - J®Ll 11� ® � I I�1� CITY/ZIP - to CROSS STREET APN f u/p ' ! (/ 1 3 PARCEL SIZE / p OWNER NAME 6y1 !0, ) 1 rI l h V/��^ PHONE � OWNER ADDRESS . CITY/STATE/ZIP ` ^ CONTRACTOR `6 " � ey'b d 4gyJ S XrL�-�`"' �'JpPHONE YP Z I/mp CONTRACTOR ADDRESS C,7-- CITY/STATE/ZIP LICENSE EIC-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X V ❑ PERC TEST ' #- BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK:3 ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS:`r' NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft 0. ❑ LIFT STATION SIZE ' TYPE OF PUMP ! ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ -LEACH LINES ❑ LEACHING CHAMBERS' #OF LINES LENGTH OF LINES ft O DISTANCE TO NEAREST WELL .x ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft �' 1` DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r i l ❑ 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 13DISPOSAL PONDS WIDTH r'.'": :.ft'•, LENGTH ;. 'ft. DEPTH ft rDISTANCE TO NEAREST WELL - ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH 4 ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE z ft � o 1 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. t MINIMU HOUR ADV CE NOTICE REQUIRED FOR INSPECTIONS—P ASE CALL(209)953-7697 ! oL10:7 SIGNED TITLE f DATE OI \ I_ , 0 \ r' IfEl ry \ � )T,( Q M. hUtzA T �a , e DEPARTMENT U O JLY c / t Application Accepted By Date �p It 6� Area Employee ID#: -737'? r --Final-Inspection-By--- _ _ Date-._li.�.l-2t __. ❑.SPECIAL PERMIT-Approved by.. -.6.:,r-•.- f.-.rte --�----< --a: Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTSt�j PE SC Received Check#// Amount Date Permit/ Invoice# Permit ID# - Code INFO By as Remitted Service Request# F 42-02-001 - �e. ONSITE WASTEWATER PERMIT , 12/22/2003