SR0085024 - Laserfiche WebLink

Home Browse Search

y� ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE �}PERMIT JOB ADDRESS 1 W r L ti 'ECTIONS (+ t tXPIRES l YEAR FROM UATE ISSUE CITY/ZIP J 7 a cit4, n eA CROSS STREET-�/I�,� APN i� O Uri PARCEL SIZE jl �+ OWNER NAME )� P IP ii V)�A KJ%P�% i�J^l %�If1�_ _ PHONE OWNER ADDRESS P O ' Vy/1 c Q p � CITY/STATE/ZIP R) j2C) 7 L/� ! CONTRACTOR 4 !(SZS /.[ e -a � � 5,C � 2 r PHONE 41 5L . CONTRACTOR ADDRESS 1Y I� .�� Z1 CITY/STATE/ZIP I�/� C -40--e e -V- LICENSE ❑OC -42 ❑LIC -36 OTHER NUMBER(j►T29SI-44 EXPIRATION DATE )S2 f/.I- WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: ❑ PERC TEST # BUILDING PERMIT #,— TYPE OF WORK: L1 _NEW INSTALLATION !-I- REPAIR/ADC Coordinates X LAND USE APPLICATION #, )N ❑ ENGINEER DI Y TERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: IIJ/RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ! NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 7 0 -'-SEPTIC TANK TYPE/MFG P } L CAPACITY `DL 7-,�> gal # OF COMPARTMENTS QL ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS # OF LINES DISTANCE TO NEAREST: WELL I bO t ft FOUNDATION 36� ft PROPERTY LINE 15 t" ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. SIGNED TITLE "'i7'�)'I'� o DATE Application Accepte y --� — Final Inspection By Character of Soil to Depth o . COMMENTS ( ,1deh1W01e Date Area I G II F— ppr�, ``— Date ❑ SPECIAL PERMIT - AppttWqt Pit/Sump Soil Character: _"` Pr AL1 &44) tom(_ FLA.Vfr-_ G F ;7i'tM p" H7/5 W j v400C) wcIS Qt W11F 120:r I -r-.f y41)5 iD<naC2 PE SC Received <01010w Amount ate Permit/ Code INFO B Cash Remitted Service Re uest # Invoice # Permit ID# � S -S LEACH LINES L LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION—RE,: ft PROPERTY LINE ? ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER e1 WIDTH d ft DEPTH 0-5I ft DISTANCE TO NEAREST WELL�,� ' ft FOUNDATION ft PROPERTY LINE Z S r 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. SIGNED TITLE "'i7'�)'I'� o DATE Application Accepte y --� — Final Inspection By Character of Soil to Depth o . COMMENTS ( ,1deh1W01e Date Area I G II F— ppr�, ``— Date ❑ SPECIAL PERMIT - AppttWqt Pit/Sump Soil Character: _"` Pr AL1 &44) tom(_ FLA.Vfr-_ G F ;7i'tM p" H7/5 W j v400C) wcIS Qt W11F 120:r I -r-.f y41)5 iD<naC2 PE SC Received <01010w Amount ate Permit/ Code INFO B Cash Remitted Service Re uest # Invoice # Permit ID# s` d b IY 2 ( L 42-01 4/14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT