Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />JOB ADDRESS / 1 0 fri .„fr:::-.4.4.- ,„AEY Crrv/ZiP .t_ ?;•?,,,L1/104/ 4'115' 2.1-1-Z: <br />CROSS STREET 4!2, '1710/1/ APN 6IT <br />OWNER NAME AVe::1/1A/F 07? 6.4...-1/ <br />OWNER ADDRESS 42 5 'pax, 114-0 <br />CONTRACTOR Zel•Cle4.41,"//5 ./C W17. <br />CONTRACTOR ADDRESS //e,2 21 _44.- A/14RJ <br />LICENSE C-96 OTHER 141 NUMBER gs-kai'Xi--- EXPIRATION DATE <br />1 • <br />gAN JOAouiN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS E*PIRES 1 YEAR FROM DATE ISSUED <br /> PARCEL SIZE <br /> PHONE / .9.4S <br /> crnIsTATEizip VAti-cy 1,01444 <br />PHONE <br />CITY/STATE/ZIP C.-7117>V 404 4.5"2 <br />WATER TABLE DEPTH: 1 .1.) k 1-- i ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # --(0C4-71 LAND USE APPLICATION # PERC TEST I <br />NLY EPARTMENT SE <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />5/5/17 <br />Application Accepted By r• <br />Final Inspection By / <br />Character of Soli to Depth of 3 Ft: <br />COMMENTSuI LA t s.1-.0 A0 it A; I d L • <br />. :_.0 elP <br />Employee 10# Area Date <br />Date SPEC AL PERMIT - Approved by <br />Pit/Su p Solt Character: <br />DoLgr VOTJ2 <br />re, <br />4orz <br />L'15 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By , <br />CClitr) Amount <br />Remitted Date Permit/ <br />Service Request 1/ Invoice # Permit ID# <br />VI I I (1 _a:/.11- igo/-2—sfr1L ,4-1-t 4 a_oon-val- <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT <br /> <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: 4. F7SIDENCE COMMERCIAL <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />DESTRUCTION <br />I OTHER <br />NUMBER OF EMPLOYEES: <br />47 <br />TYPE/MFG CAPACITY ../1,2404, gal it OF COMPARTMENTS ...- <br />CAPACITY gal If OF COMPARTMENTS <br />ft FOUNDATION 3 — ,t ft PROPERTY LINE _S--. ..2 ft <br />Ci PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />,--rA SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPEJMFG <br />DISTANCE TO NEAREST: WELL /Zia )4. <br />SIZE TYPE OF PUMP <br />LEACH LINES LEACHING CHAMBERS <br /> <br />a OF LINES_ "7 LENGTH OF LINES Ca — ft <br />DISTANCE TO NEAREST WELL /./Th ft FOUNDATION / ft PROPERTY UNE r ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH tt <br /> <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SUMPS ft LENGTH WIDTH ft <br /> <br />DEPTH ft <br />ft PROPERTY LINE ft DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft DEPTH ft DISPOSAL PONDS WIDTH ft LENGTH <br />DiSTANCE TO NEAREST WELL i ft FOUNDATION <br />y SEEPAGE PITS NUMBER 5 WIrMI <br />DISTANCE TO NEAREST WELL /„, fa ' I- tl FOUNDATION <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MINIM M 48 HOUR ARVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED/"I <br /> <br />TITLE <br /> DATE <br /> <br /> 7-0 <br /> re) <br />1 11 <br />PAymENT <br />REeel vED <br />4pli+5 <br /> 2019 <br /> iJA .1hl -....AQI <br />4FA M1,1F70-geUAlry <br />LTh C'EPARj• <br />TAL <br />ENT <br /> ft PROPERTY ,LINE ft <br />ft DEPTH ft <br />.1e> 2 ft PROPERTY LINE 3" ft