Laserfiche WebLink
r 1 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE- STOCKTON CA 95205 - (209) 468-3420 <br />NON-FIEFUNDABLE PERMIT <br />Joe ADDRESS 2111 Waudman Avenue <br />CROSS STREET Thornton Road <br />OWNER NAME Denise and Anton Rivera <br />U&I-/D5/ FOR INSPECTIONS tXPIRES 1 YEAR FROM DATE ISSUE <br />CITY2IP Stockton, CA 95209 <br />080-290-260 <br />PARCEL SIZE 0.40 acres <br />15)325-4664 <br />OWNER ADDRESS 2111 Waudman Avenue CITU/STATE/ZIP Stockton, CA 95209 <br />CONTRACTOR AdvancedGeo,Inc. PHONE 800 511-9300 <br />CONTRACTOR ADDRESS 837 North Shaw Road <br />CITY/STATE/ZIP Stockton, CA 95215 <br />CA Professional Geo Brian Millman 1/31/23 <br />LICENSE ❑OC -42 ❑SCC -36 OTHER NUMBER 8574 EXPIRATION DATE <br />D <br />WATER TABLE DEPTH: 25-30 it GEOGRAPHICAL INFORMATION: Coordinates X Y <br />Id PERC TEST # 1 BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM Ll DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTICTANK TYPE/MFG CAPACITY _ gal #OF COMPARTMENTS_ <br />❑ GREASETRAP TYPE/MFG CAPACITY _ gal #OFCOMPARTMENTS_ <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />O LEACH LINES ❑ LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES it <br />Amount Date Permit/ Invoice# PermitID# <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION__ <br />ft PROPERTYLINE_ <br />aaa <br />❑ FILTER BED WIDTH <br />it LENGTH <br />_ ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE <br />/ V <br />O MOUNDED WIDTH <br />it LENGTH <br />It DEPTH _ _ _ it <br />�O <br />DISTANCE TO NEAREST <br />O SUMPS WIDTH <br />WELL <br />it LENGTH <br />it FOUNDATION <br />it PROPERTYLINE <br />=ft <br />it DEPTH <br />116202, <br />- <br />DISTANCE To NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE <br />❑ DISPOSAL PONDS WIDTH <br />it LENGTH <br />it DEPTH L_'_ NV/ <br />V/NC <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE crNf� P ENTq NTy <br />O SEEPAGE PITS NUMBER <br />WIDTH <br />ft DEPTH n <br />qRT MFNT <br />DISTANCE To NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE n <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />MW/MUM 48 HOUR ADVANCE NOTICE <br />REQUIRED <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />DEPARTMENT S ONLY <br />Application Accepted By /� `� Date 3 �6 f� Area �� Employee ID# DA <br />Final Inspection By i Date 'Za-Z C1SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: PyI Sump Soil Charaac.Acter: <br />COMMENTS �e`e -' y'$ ''kw' /ice %' A,61 <br />PE <br />SC Received <br />Check#/ <br />Amount Date Permit/ Invoice# PermitID# <br />Code <br />INFO B <br />Cash <br />Remitted Se;VicejRequesj # <br />aaa <br />5,R3 401 <br />Vj3'&__j <br />4 S7 3 Z ONSITE WASTEWATER TRTMNT SYSTEM PERMIT4/14//14/ 18 <br />