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SR0083411_SSNL
Environmental Health - Public
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2600 - Land Use Program
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SR0083411_SSNL
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Entry Properties
Last modified
4/8/2021 4:54:02 PM
Creation date
4/8/2021 4:49:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SR0083411
PE
2602
FACILITY_NAME
19960 S SAN JOSE RD
STREET_NUMBER
19960
Direction
S
STREET_NAME
SAN JOSE
STREET_TYPE
RD
City
TRACY
Zip
95304
APN
20929032
ENTERED_DATE
3/16/2021 12:00:00 AM
SITE_LOCATION
19960 S SAN JOSE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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SAN 50AQIBN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVIsi <br />1 <br />LIQUID WASTE PERMIT <br />304 E WEBER AVE. 3" FLOOR, STOCKTON, CA 95202 (209)468:A20 <br />VONAVUNDARLE PESiLMp' EXPIRES I YEAR FROM DATE ISSUED <br />i,--I Ft 1"4 CDMI Ci <br />E Ce Li Sr <br />PC) F2 A LL. <br />JOB ADDRESS '‘P 3- SA9 (11 " I NEW EC-11 G N 1 ___ arran, Ie PARCEL SIZEJAPN 2.O7 X71207--- <br />-).'1921.1 OWNER NAME 7.-C,- '7:4 ADDRESS 1532,C§EC‘....2 irer5 <br />CITYMP 7.-I9.04)7# PHONE <br />CONTRACTOR < ADDRESS WI ;VW. <br />CITYIZIP PHONE 1-1 ----ip-i 5 f t i <br />GEOGRAPHICAL INPORN{ATION: COORDIANTES: X Y TOWNSHIP RANGE SECTIO..I <br />EERC TESTIS) I I HOW MANY APPLICATION*, <br />TYPE OF Stk.& iC WORK, ri NEW INSTALLATION lir REPAIR/ADDITION 0 DESTRUCTION <br />IN: STALLA TION WILL SERVE leRESIDENCE 0 COMMERICIAL 0 OTHER .,..,_ .._„: <br />NUMBER OF LIVING UNITS: •417 NUMBER or BEDROOMS L : NUMBER OF EMPLOYEES : <br />CHARACTER OF SOIL TO A DEPTH OF 3 FEET: Al? 6 ige9- PIT/SUMP SOIL CHARACTER: WATER TABLE DEMI a SEPTIC TANK/(3REASE TRAP TYPE/MFG 1244.-4 CAPACITY NUMBER A .,....e,40 a:cow...m.1E1,m5 <br />74-.00'7--. <br />El PEG TREATMENT PLANT DISTANCE TO NEAREST_ WEU,422_ e FOUNDATION vIer7 PROPERTY LINE ../eAt:' <br />E:1 LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />WLEACHING LINE LIME NUMBER & LENGTH OF LINES / "Or) INFILTRATOR CHAMBERS <br />-7- vg•-1C DISTANCE TO NEAREST WELL/ I_ FOUNDATION R*--1" .ROPERTY LINE i'leej C FILTER BED worm LEscril DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION. PROPERTY UNE <br />0 MCKENDE) WIDTH LENGTH DEPTH <br />DISTANCE To NEAREST: WELL FOUNDATION PROPERTY LINE <br />0 SEEPAGE Prrg ;wpm LENGTH DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE,..._____ <br />0 sumPs WIDTH LENGTH DEATH <br />DISTANCE TO NEAREST WELL FOUNDATION PROPERTY LINE <br />(3 DISPOSAL PONDS WIDTH LENGTH DEPTH <br />DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND ME WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN 'COUNTY ORDIANCIS, STATE WS, AND LATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED: <br /> <br />N 7-.-Ap-r Tru:__C_VSWOR - pAT _ <br />---i-ammiAp ria wy_relimptimpisizra k immiummii=lcciairjav, 111111111111 1 1111111MIL-J ill ?1111111111111111111111111111111" ".....-4 . -- r-1111,111111111 A iswE v <br />..... V. .,_ <br />i i <br />Mil <br />-4 <br />1 0 Mil , 17-717.P.!;!.. <br />air -. , 1 &MO <br />BMII16:1111111111111111111111 11311111111 MOM IEVII 11111M111111TA 111111M11111111 II - <br />simimmain 1M ti Immiwgi. litIVIMO <br />,',71/;;A:,k,:lt I. <br />MI 111111111111111111MMI 1011111111111111101111111M1111 IIIIIMIIIIIIIII WIll 11111111111111111111:111 i IMO Fo. DEPARTMENT ISIS <br />APPLICATiON Acria.naniy- A /"%.' ..,.... ‘ <br />ONIN <br />. .ATE %AA 4)1/ <br />'If. TANK. PIT. OR St:UP ENSPECTED BY . larnalrlagallierArlar . <br />FINAL rNSASZ-TION ...... .e. Ir <br />_DA <br />„4 COMMENTS ,it- . A.2... • 'I'Ae./ y&F7IMilee .g::L.11 Affirl AeLl <br />- <br />AWL id / .LI.A Jr • <br />PR CODE SC <br />INFO AMCUNT, <br />kiINTITED <br />CII:Er t <br />C-k-SR RECO VPD EY nATE SEPTIC LW ...• ....-- <br />0 .. 7. 1 4,3 1 / . .• . $ _ 1- f-i lb et N47ii 1:1 i , (Arviii 1/2441 ,42-/t, )15 4 cAt, -if I/ di ,06 ai g q ( it 44- ' )
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