SR0078815 - 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 IVUN-MEFUNUABLE JOB ADDRESS V &Flimlapo CITY/IlP L<)a f LAND USE APPLICATION # 1/ 0 C11 'I UG 3 �7 ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT CROSS STREET I C APN 4 PARCEL SIZE OTHER • I� NUMBER OF EMPLOYEES: ft DEPTH ft OWNER NAME i {/"G i _ PHONE gal #OF COMPARTMENTS I �J A t% `S �y S�) q U OWNER ADDRESS CrryISTATEMP "%' •) ❑ PKGTX PLANT CONTRACTOR 4�114" I1�r�l� �`� PHONE _ - (�L / Y6 TJ9 CONTRACTOR ADDRESS C/ �L(L ®I J(C 0 Pe CITY/STATEMP a� /� /� 6,o ,i ( LICENSE )�-42 C-36 OTHER NUMBER �ss� EXPIRATION DATE ' ' -?,o — /f DEPTH It WATER TABLE DEPTH: A ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # _ # OF LINES f LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDRION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: pp RESIDENCE COMMERCIAL 1q OTHER NUMBER OF LIVING UNITS: _ Y NUMBER OF BEDROOMS:_ J NUMBER OF EMPLOYEES: ft DEPTH ft ❑ SEPTIC TANK TYPE(MFG�i1.�I7 �y CAPACITY gal #OF COMPARTMENTS ❑ GREASETRAP TYPEIMFG CAPACITY gal #OFCOMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE It ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) C� LEACH LINES LEACHING CHAMBERS _ _ # OF LINES f LENGTH OF LINES 7 ft DISTANCE TO NEAREST WELL ft FOUNDATION Q ft PROPERTYLINE , ft ❑ FILTER BED WIDTH It 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 PROPERTYLINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTYLINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft q SEEPAGE PITS NUMBER_ I WOTH y It DEPTH aS ft DISTANCE TO NEAREST WELL (OO ' It FOUNDATION �O It PROPERTYLINE S ft I HEREBY CERTIFY THAT 1 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. Character of Soil to Depth of 3 Ft: _ Pit/Sump Soil Character: COMMENTS t l y- I/ (/ l/ t ski i fol k i t' '--I . PE SC Received Ch Amount Permit/ Code INFO BY n ^Cash Remitted Date Service R JJ Request Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 424112 41 PAYMENT RECEIVED 4AR 0 y 2018 JOAQUIN COUNTY NVIRONMENTAL LTH DEPARTMENT