SR0087223 - 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 , . 1C1 ALL 209 953-7697 FOR INSPECTIONS L EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �� Z 5 `cs o mo CITY/ZIP C7 A�` G� CROSS STREET Lt bi;-�A l v APN OO-NO o - 19 PARCEL SIZE ' OWNER NAME S A� M U,�t Z PHONE y OWNER ADDRESS S`ArNk 4>l S iA1 b 4 CITY/STATE/ZIP CONTRACTOR\J4L5�1�" ,� � �t1J 'I k"j ` PHONE zzlo) -�/��15c) -7 30 �) CONTRACTOR ADDRESS ✓,t) Mf4_)"w 0\ 51'(Lc i CITY/STATE/ZIP `-may' �- CA- C,)S Zy LICENSE I S I IC-42 ❑i 10-36 OTHER NUMBER 42�S t t J l EXPIRATION DATE l .:>7"C J WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: K NEW INSTALLATION 1 REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE V ❑ REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 1 DESTRUCTION t INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER (n NUMBER OF LIVING UNITS: (�1 NUMBER OF BEDROOMS: 1 `> NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CST CAPACITY ` gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL t�J ft FOUNDATION ft PROPERTY LINE So ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ P G TX PLANT ❑ SAND1L SEPARATOR(ENCLOSED SYSTEM fP �k x 2 ❑ LEACH LINES LEACHING CHAMBERS 11-4 f N\}f A(U' #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL V 0''20 ft FOUNDATION 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 It DEPTH ft I 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 LINE ft 14- SEEPAGE PITS NUMBER 3 WIDTH 17a'' ft DEPTH LS it DISTANCE TO NEAREST - WELL %C:Jr—> ft FOUNDATION 1 ft PROPERTY LINE 13 ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUM 48 HOUR AaZMqkMMCE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED A 10e I TITLE1?f r•J t� DATEy1• ZJ Z-? t I -a- I L - _ / u3Eau _ - E A M NT J!� DEPARTMENT U E 0A1 LY Application Accepted B Date Area "PERMIT Employee ID# Final Inspection By (Lt/ /2 S❑ SPEC -Approved by Character of Soil to De i w a Pit/Sump oil Character: /[ - COMMENTS D PE NF Receiv Check#/ Amount Permit/ Date Invoice# Pertni # Code INFO ash em"^' Service Re uest# 6 "" ,q_-2L13 JCICs 42-018 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT�� r (. !J , ^�•S -FIKg64.