SU0014060 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATEF TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ' 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468.3420 NON-REFUN MIT CALL 209 53-7697FORINSPECTIONS EXPIRE 1 Y F M DATE ISSUEC JOB ADDRESS 811 _. _._ _ _ __CITY/ZIP ___ CROSS STREET e{ APN_- PARCELSRE ,S OWNER NAME_ - , _ PHONE tAi 4 � 2-1 OWNER ADDRESS , ...(_!..�-- CITY/STATE/y�ZIP CONTRACTORD, ' e _..._L_N L PHONe/t (a-6 607 CONTRACTOR ADDRESS 4-6W ts).10115o�si CITY/STATEIZIP //y�� LICENSE C-42 I C-36 OTHER • � NUMBER _1005U_E%PmATION DATE M_ l WATER TABLE DEPTH: Of) K A UW n it GEOGRAPHICAL INFORMATION: Coordinates X v _ PERC TEST IfBUILDING PERMIT # _ _ LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADOMON ENGINEER DESIGNED /ALTE9NATIVE REPLACEMENT 0UT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION C(n )\ INSTALLATION WILL SERVE: RESIDENCE U COMMERCIAL 1i OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: _. NUMBER OF EMPLOYEES: I SEPTIC TANK TYPE/MFG_ APACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENT'S DISTANCE TO NEAREST: WELL T _ N FOUNDATION ft PROPERTY LINE 'f off ❑ LIFT STATION SIZE TYPE OF PUMP_ O PKG TX PLANT Q SAND OIL SEPARATOR (ENCLOSED SYSTEM) lid' LEACH LINES x LEACHING CHAMBERS 04 #OTLINES LENGTH OF LINES I ft 0 /�/ 30 DISTANCE TO NEAREST WELL ft FOUNDATION_ it PROPERTY LINE ft Cl FILTER BED WIDTH __ __ _ it LENGTH .____ U DEPTH _ it DISTANCE TO NEAREST WELL _ H FOUNDATION it PROPERTY LINE if ❑ MOUNDED WIDTH—_ --it LENGTH _ _._._.—. tt DEPTH if DISTANCE TO NEAREST WELL ._. _. it FOUNDATION _ fl PROPERTY LINE it ❑ SUMPS WIDTH _. it LENGTH _ ft DEPTH _ it DISTANCE TO NEAREST WELL ._ K FOUNDATION If PROPERTY LINE_ it ❑ DISPOSAL PONDS WIDTH N LENGTH ____ ft DEPTH _ If DISTANCE TO NEAREST WELL N FOUNDATION N PROPERTY LINE it ❑ SEEPAGE PITS NUMBER _, WIDTH__ it DEPTH it DISTANCE To NEAREST WELL M FOUNDATION it PROPERTY LINE it 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 1I1AT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. I HO A E I E QUIRED FOR LNWfLWNSjPLEASF CALL 209 953-79R7 7 i d ! SIGNEDUOV _ TITLE__ �"�i;'.lw_. DATE _ Application Accepted By Final Inspection By_ Character of Soil to Dept COMMENTS QFO I.no �d DEPARTMENTUSEONLY Date___ & ? � Area S Employee ID# Lick Date.I I SPECIAL PERMIT - Approved by M 5 I 42.07 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 56117