SR0085282 - 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-KEFUNDABLE Y JOB ADDRESS CROSS STREET OWNER NAME �C � GJJ''TYIZIP L_�.t J 6 `/ APN S3 3 OOS PARCELSIZE Ira OWNER ADDRESS S6104e e CITYISTATERIP�/j(,{ 2 /y- �j CONTRACTOR I"qI vI L PHONE X 13(t_ /`{/—_'T o;L7 CONTRACTOR ADDRESS I W.. ee� �' f1 CITYISTATEITJP ci�jT -C F•'�\y/a � t (4 / Sd )� LICENSE KC -42 C-36 OTHER NUMBER �/� E ,,RATION DATE / J —P� WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIRIADDIT10N ENGINEER DESIGNED IALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: X RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG - Y G CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I HEREBY CERTIFY THAT 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. OT DEPARTMENT SE ON Y Application Accepted By 2 Date S rea ` Employee ID# y 4yik 6 Final Inspection By Date �' 2� SPECIAL PERMIT -Approved by Character of Soil to Depth o Pt: Pi /Sump Soil Character: COMMENTS UnCletermjn l i pr U . E.Xistjnt Foci t4 fe.mwn� PE SC ReceivedCh Amount Date Permit) Invoice # Permit ID# Code INFO Remitted I Service Request# o 1$` 3a0 t o 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 ANT ED 2072 o uNTY MENTI LEACH LINES LEACHING CHAMBERS # OF LINES o� LENGTH OF LINES 14 / ft DISTANCE TO NEAREST WELL ' �� ' ft FOUNDATION '�_ ft PROPERTY LINE R ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It SEEPAGE PITS DISTANCE TOEAR ST WELL Numseiz WIDTH ft FOUNDATION ft PROPERTY LINE R ft DEPTH o�•�S' ft DISTANCE TO NEAREST WELL I O401 ft FOUNDATION O ft PROPERTY LINE �� A It I HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. OT DEPARTMENT SE ON Y Application Accepted By 2 Date S rea ` Employee ID# y 4yik 6 Final Inspection By Date �' 2� SPECIAL PERMIT -Approved by Character of Soil to Depth o Pt: Pi /Sump Soil Character: COMMENTS UnCletermjn l i pr U . E.Xistjnt Foci t4 fe.mwn� PE SC ReceivedCh Amount Date Permit) Invoice # Permit ID# Code INFO Remitted I Service Request# o 1$` 3a0 t o 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 ANT ED 2072 o uNTY MENTI