SR0084664 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209)468-3420 NON-REFUNDABLE PERMIT CALL 209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROMDATEISSUE] JOB ADDRESS ttie S t L.an..4- CITY/ZIP zo CROSS STREET p'n✓J�( y Jye APN l i�S �� / PARCEL SIZE OWNER NAME syI,( owl - PHONE � 24-9�;-5cj OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATEIZIP LICENSE ❑LC -42 ❑0C-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/ADDITION [i ENGINEER DESIGNED / LTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM )( DESTRUCTION C J1 k INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP ❑ LEACH LINES L LEACHING CHAMBERS I CAPACITY CAPACITY ft FOUNDATION ❑ PKG TX PLANT # OF LINES FOUNDATION gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) DISTANCE TO NEAREST WELL FOUNDATION ft ❑ FILTER BED WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ❑ MOUNDED WIDTH ft LENGTH DISTANCE To NEAREST WELL ❑ SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ❑ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ❑ SEEPAGE PITS NUMBER WIDTH _ DISTANCE TO NEAREST WELL I CAPACITY CAPACITY ft FOUNDATION ❑ PKG TX PLANT # OF LINES FOUNDATION gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ft FOUNDATION LENGTH OF LINES _ ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STAT WS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 4 AD AN OTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED I ' TITLE 4WnF'YL- DATE -2-9))e'C2-1 / DEPARTMENT US6 ONLY C Application Accepted By r L L� Area Employee ID#_ Final Inspection By G Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Dep of'3 Ft: it/Sump Soil Character: COMMENTS ('�Y1�� / lb C }jZ <PWe1r PE Code ft ft FOUNDATION ft ft FOUNDATION ft ft FOUNDATION ft ft FOUNDATION ft FOUNDATION LENGTH OF LINES _ ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STAT WS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 4 AD AN OTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED I ' TITLE 4WnF'YL- DATE -2-9))e'C2-1 / DEPARTMENT US6 ONLY C Application Accepted By r L L� Area Employee ID#_ Final Inspection By G Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Dep of'3 Ft: it/Sump Soil Character: COMMENTS ('�Y1�� / lb C }jZ <PWe1r PE Code SC INFO Received By Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# Haat c,�s ts.�, Isa 1 Z 42-01 �� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/16 r