SR0080104 - 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 p EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �2 9a27 WF s�R/9onl RA r CITY/ZIP CROSS STREET 1/7 iqa o� APN PARCEL SIZE L. d d OWNER NAME Sr=TY7( / ,"T-11` 9AE PHONE .�q'qQ��" OGS, OWNER ADDRESS 102 fat 7 W"-r A/PO/s CITY/STATE/ZIP�J Q/I DN . a4 7 y�3GG CONTRACTOR CNE5 V A-r r u1.Tr�/4 PHONE CONTRACTOR ADDRESS . D r nX 3 7 1Y CITY/STATE/ZIP Gf RLO G.L G �S�R� LICENSE ❑ iC-42 ❑ IC-36 OTHER !�� NUMBER EXPIRATION DATE /Z JP W ER TABLE DEPTH: �"- ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: I I RESIDENCE C COMMERCIAL 11 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES 1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL 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 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 LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MIA114LIM 48 HOVRADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953 7697 SIGNED TITLE!ni/✓1Lj!57/1II� � DATE I all A J A R PARTMENT USE. NLY RTMENT Application Accepted By Date AreaACIAL Employee ID# Final Inspection By Date 1_I SERM IT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE Sc Received heck# Amount Date Permit/ Invoice# Permit ID# Code INFO By as Remitted (fService Request# s. 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17