SR0082446 - Laserfiche WebLink

Home Browse Search

ti 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)95�3-7697 FOR INSPECTIONS � EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS Z 60 A '? 17t-&,2 i&x CITYIZIP / A 61!)n rQ � G i- CROSS STREET `�7T �/'1 C'E G�/ _ APN QQJ�I(i Od�/ PARCEL SIZE I r OWNER NAME (� Gam/S di: PHONE �J T OWNER ADDRESS Z& D b 7 �Twit-,EV _ CITY/STATE/ZIP I 1 !;_ Qt CONTRACTOR .-��7?tL4te 4V- Se-412 L)I LEJ C _ PHONE qI Gi - 7 0-i 6 Z ��_- CONTRACTOR ADDRESS Y' F OX �Z�� —CITY/STATE/ZIP LICENSE ❑0C-42 DJC-36 OTHER__ NUMBER-I Ot p L//XXPIRATION DATE y 3 7 07 Z WATER TABLE DEPTH: I be4 N c U ft GEOGRAPHICAL INFORMATION: Coordinates X_ Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION I.I REPAIR/ADDITION i I ENGINEER DESIGNED 1ALTERNATIVE S;1 r I. REPLACEMENT U OUT-OF-SERVICE SEPTIC SYSTEM f DESTRUCTION L P l R p Irl, INSTALLATION WILL SERVE: Ia RESIDENCE ❑ COMMERCIAL OTHER Af O-C b GP,►V1e /� r NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG P r L W+VG i/lD�lo( _ CAPACITY IZ©b 64X gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL N/T,r�_—f t FOUNDATION + l� ft PROPERTY LINE io ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 31( LEACH LINES LEACHING CHAMBERS #OF LINES_ _ LENGTH OF LINES I DD Z--4- ft DISTANCE TO NEAREST WELL ft FOUNDATION 5+ ft PROPERTY LINE /d ft ❑ FILTER BED WIDTH ft LENGTH_ ft DEPTH It 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 It ❑ 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 It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I I IEREBY CERTIFY THAT I 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. MINIMUM 48 H R 4DVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209)953-7697 D SIGNED TITLE V DATE ZC?LG (N G- V R N NS NUT IrA / DEPARTMENT USE ONL Application Accepte yam_ Lam` Date /! dU Area y % � Employee ID# D� Final Inspection By Date ')r( Zb Ly FI SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: < <>c — Pit/Sump Soil Character: COMMENTS For Se+W1e Ibong/c,/t Shdio 1A �J"�-T 53SS� S14rcl thed buil in Qc rti�t�l OiG� ____QiCiQ MSC-- ---%,C> �►J c-W.P _ 06&z 0IF Ol-P S!!l S 'C/" R-6,34 PE SC Received / Amount Permit/ Date Invoice# Permit ID# I(RNh Code INFO Remitted Service Request# Nay 1j)-7 u— 2 �gy ►I �o O(A2'1-11( -- - 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118