SR0078356 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE P RMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED -, -11 JOB ADDRESS CIcc)'5;2424 MMTY/ZIP / i 67 CROSS STREET LAC7W" > A47APN r V ( PARCEL SIZE L OWNER NAME )0<1,49*_ � ��yg Jubp <--jr2w Tl PHONE Zo �fi 434=1 F OWNER ADDRESS �� K x �- CITY/STATE/ZIP �r��— -rb�1 l 7 CONTRACTOR '"� � _ PHONE 2_40/� p C� 3 CONTRACTOR ADDRESS iQ!-t�L�L- _"_CITY/STATE/ZIP S A-riS PA LICENSE CII C-42 111 -IC -36 OTHER NUMBER EXPIRATION DATE- WATER ATE__ WATER TABLE DEPTH: wL+ It GEOGRAPHICAL INFORMATION: Coordinates X L PERC TEST # BUILDING PERMIT # LAND USE APPLICATION #E+4>LTF TYPE OF WORK: NEW INSTALLATION R AIR/ADDITION ENGINEER DESIGNED REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE I I COMMERCIAL OTHER " $L n � r NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:, ,� lull" CFDTIC TANK TvPF/MGr CAPACITY ) &zC-r_> aal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL tijp 41' ft FOUNDATION 1OF/{ ft PROPERTY LINE 457,Fr ft ❑ LIFT STATION SIZE _ TYPE OF PUMP-_ _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) Application Accepted Bye Final Inspection By Character of Soil to Depth of COMMENTS SMAA NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 �11 TITLE e__ lW WVV4Z DATE ( I - r DEPARTMENT U E ONLY 1 Date ..rzj, 44r_ Employee ID# VJ/Q_ ate 2— ❑ SPECIAL PERMIT -Approved by _ Pit/Sump Soil Character: PE Code LEACH LINES ❑ LEACHING CHAMBERS _ # OF LINES LENGTH OF LINES `'t' -z FT_ It hec as DISTANCE TO NEAREST WELL ft FOUNDATION ID V'T ft PROPERTY LINE �� ft ❑ FILTER BED WIDTH —_ It LENGTH _ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH It LENGTH _ ft DEPTH it DISTANCE TO NEAREST WELL _ ft FO NDATION ft PROPERTY LINE It SUMPS WIDTH 1�r It LENGTH __ -, _ It DEPTH !S FIC It DISTANCE TO NEAREST WELL It /+ FOUNDATION It PROPERTY LINE rr It ❑ DISPOSAL PONDS WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION _ It PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH _ It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It 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 I AM IN COMPLIANCE WITH ALL WORKERS COMIZENSAIIONlAWS_ Application Accepted Bye Final Inspection By Character of Soil to Depth of COMMENTS SMAA NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 �11 TITLE e__ lW WVV4Z DATE ( I - r DEPARTMENT U E ONLY 1 Date ..rzj, 44r_ Employee ID# VJ/Q_ ate 2— ❑ SPECIAL PERMIT -Approved by _ Pit/Sump Soil Character: PE Code SC INFO Received hec as Amount Remitted Date Permit/ Service Request ## Invoice # Permit ID# Z .2�W/'� 77�A` -- 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 '7.