SR0083791 - Laserfiche WebLink

Home Browse Search

ONSIT WAS TE 'TER TREATMENT SYSTEM PERMIT I1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3"° FL- STOCKTON CA 95202 - (209) 468-3420 i NON-REFUNDABLE PERMIT I CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEARFROM DATE,I UED r JOB ADDRESS%%�Q��+>a� '�"�1/� CITY/ZIP CROSSSTREET /VCl✓ f�`�idF APN fjO �ZZO " PARCEL SIZE Yid OWNER NAME- �!�!/%__r__ �T__il/.7� 7 (PHONE OWNER ADDRESS .CITY/STATFJZIP CONTRACTOR / PHONE - SO - CONTRACTORADDRFSS_ __ _ _ .CITY/STATE/ZIP LICENSE -42 ❑ C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH' ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST' # ' BUILDING -PERMIT # LAND USE APPLICATION # ` TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDfIION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: '9Y RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBEROF BEDROOMS: 3 NUMBEROFEMPLOYEES: ❑ SEPTIC TANK ' TYPE/MFG - - CAPACITY . /7700 gal # OF COMPARTMENTS oZ ❑ GREASE TRAP TYPE/MFG " - CAPACITY f gel:. ,# OF COMPARTMENTS ..- i., L3.PKGTXPLANT DISTANCE To NEAREST: 'WELL fl FOUNDATION /_5 ft PROPERTY LINE '�S ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) El LEACH LINES n, IS SO LEACHING CHAMBERS # OF LINES Z LENGGF LNE ft „\1 , i ZZ R PROPERTY LINE DISTANCE TO NEAREST WELL ./ ft , FOUNDATION ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft • DISTANCE TO NEAREST WELL ft FOUNDATION - ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl ( EISUMPS WIDTH- ft LENGTH R DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH ft LENGTH' ft" DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION. ft - PROPERTY:LINE ❑ SEEPAGE PITS NUMBER WEDTH ft r DEPTH DIS'T'ANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE i I HEREBY CERTIFY THAT 1 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.- OUNTY.MINIMUM MINIMUM24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASSE CALL (209) 953-7697 -,-,,v,DATE �. SIGNED �t% TITLE Application Ace i Final Inspectio Ey. Character of So COMMENTS 2! X ._ 1.. IN ■■ 0■■■■■■■■■BMMM■Ylliidet■_e®��II•s■�� loll v■■■■■UR■■■N■��■eon■■■■■Q�■■■ I®®Ldp!��®�!®®��J®®®��w�®��L■A��1 Date ■ SPECIAL PERMIT -Approved by A/Pit/Sump Soil Character: PE SCReceived Amount .Date Permitl Invoice # Permit IDN . Code - -INFO- B a .Remitted Service Request # ZIO , 6a 23�• s IS b SeZo5o y