SU0013552 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOUIN CO#NTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON Avrnwr-STOCKTON CA 95205-(209)468-3420 NON-FUNDABLE PERMIT CALL 209 9953-7697FORINSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS I I S �•;. j K(1 1jLan - _ CrrY/ IP` CROSS STREET /r 1��r �11 APN OG S V A 0 20 PARCEL SIZE /1I t> OWNER NAMESq UQ 140y' W'Qf�I�M//,,111� P•FIIONE A_I Q�'-�Uv`8 i OWNER ADDRESS i`7 I5 I 7 J• 1�/1\l w\l'�� ' _ CrrY/STATE/ZIP ( _I.i A l 5�-1y CONTRACTOR_ __ PHONE CONTRACTOR ADDRESS _ _ CITYISTATNZIP LICENSE I I C-42 i 1 C-36 OTHER__.. _ NUMBER _ EXPIRATION DATE _ WATER TABLE DEPTH: G h _ It GEOGRAPHICAL INFORMATInN Coordinates X Y PERC TEST # BUILDING PERMIT#_I I (� U S4_�LAND USE APPLICATION a1 TYPE OF WORK: NEW INSTALLATION REPAIWADOtTION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE I I COMMERCIAL OTHER NUMBER OF LIVING UNITS: _- _1 NUMBER OF BEDROOMS:_ r'// NUMBER OF EMPLOYEES: UK SEPTIC TANK TYPE/MFG _ _ _ _ CAPACITY 2siSL_ gal #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG _ jj CAPACITY �� gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL I vL/_y ft FOUNDATION L1 _ 11 PROPERTY LINE 51/r it ❑ LIFT STATION SIZE _ TYPE OF PUMP _ 0 PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) Id LEACH LINES XLEACHINGCHAMBERS #OFLINES� 3- __ LENGTHOFLINES ^ `S.�y ft DISTANCE To NEAREST WELL )uu X.. h FOUNDATION 10 �- n PROPERTY LINE _ It ❑ FILTER BED WIDTH It LENGTH ---ft DEPTH It DISTANCE To NEAREST WELLIt FOUNDATION It J PROPERTYLINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH it DISTANCE TO NEAREST WELL _ It FOUNDATION ft PROPERTY LINE it ❑ SUMPS WIDTH It LENGTH__ ft DEPTH 1t DISTANCE TO NEAREST WELLIt FOUNDATION It PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH__ II DEPTH ft DISTANCE TO NEAREST WELL (eft VOUNDATION If PROPERTY LINE it I/SEEPAGE PITS NUMBER WIDTH _ DEPTH S ft DISTANCE TO NEAREST WELL I S n It FOUNDATION G'r ft PROPERTY LINE 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS� -�PLEASE CALL 209 953-7697 SIGNED µ- : r/Ls,-%.t_ TITLE _. .yWlt�r DATE___ 31 1 14 Ifni I P1 Application Accepted By _1 /_ Date ( _ Alea Employes ID« Final Inspection By Date1�w ��— Ll SPECIAL PERMIT-Approved by Character of Soil to D h o _ _ _ Pit/Sump Soil Character:_ COMMENTS PE Sc Received C #/ Amount Date Parm W Invoice# Permit ID# Code INFO Cas Remitted Service Request# -41a 21-1 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT SW17