SR0083214 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNT ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 4683420 non-KEFUNDABLE PERM, IIT CALL209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE] JOB ADDRESS �(�� W1w� h i j QU � I `w `�y Cm/ZIP SERVE: RESIDENCE CROSS STREET Ir1�Q. /� [7 • APNSJ [; 0,3 Ci 0,' PARCEL SIZE J j�itT OWNER NAME 1/lA L��U„ '(J �1 Tl� \C[(� Q -PHONE'12� • 325.4�ra'� OWNER ADDRESS TYPE/MFG P 4 L _ CITYISTATEMP ❑ n CONTRACTOR V Ve. J�+��.��1{►'►�(��'- 1217Q 1,,np ,�c PHONE (2 /�j.1 Q �7 q 1) 33`•I 7,39 CONTRACTOR ADDRESS 33 ,, y�� -�t!,4io1., M6t.XWC ( I P • �f./� CITY/STATPJZP LO d,, CN 9S2 ' v LICENSE ❑.-. C-42 El -.C-36 1 // OTHER I"J NUMBER I t5-7 EXPIRATION DATE 2-OZ3 WATER TABLE DEPTH: ❑ PERC TEST # TYPE OF WORK: ft GEOGRAPHICAL. INFORMATION: Coordinates X Y BUILDING PERMIT # LAND USE APPLICATION # 1r' NEW INSTALLATION ( REAIRIADITION ENGINEER DES ]}/ NLE!D (/ TERNATIVE q lie -j! OIT i` IdUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION Amount Remitted INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER � NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: V SEPTIC TANK TYPE/MFG P 4 L _ CAPACITY Iwo gal # OF COMPARTMENTS ,r ❑ GREASE TRAP TYPEIMFG CAPACITY _ gal # OF COMPARTMENTS r T DISTANCE TO NEAREST: WELL �7l J' fl FOUNDATION ID -r ft PROPERTY LINE C,3+ ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKO TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft J DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE fl Sid FILTER BED WIDTH Ln 2. ft LENGTH 15 R DEPTH �(, f( DISTANCE TO NEAREST WELL ':—)0T it FOUNDATION ff PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH R DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION N PROPERTY LINE ft ❑ DISPOSALPONDS WIDTH ft LENGTH R DEPTH ft DISTANCE TO NEAREST W ELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ ft I HEREBY CERTIFY THAT I 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, DEPARTMENT US ONLY /�/' Application Accepted By �L Date ! .� . Area -� i `7� Employee ID#A_ Final Inspection By L Date L L� : ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of Ft: Pit/Sump Soil Character: COMMENTS SYStFI�' t2 -t SY/rfek'l LO PE Code SC Received Check#/ INFO Cash Amount Remitted Date Permit/ Invoice # Permit IDA Sefv a R oast iF a ►o ; s 3�� � 42-01\/y(/ {/'/' ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4.'14/18 LE%� �� 3 O/ /