SR0085058 - Laserfiche WebLink

Home Browse Search

% M ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 IVUN-Mtt-UNUAtfLt rtKMI l CALL (ZUY) 953-/b9/ FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS �UW % L /�OXCS/ �� C k��[- CITY/ZIP AQ!L, CROSS STREET ��,iC [(; APNO'E_70 0 '1)— PARCEL SIZE + I OWNER NAME Ot4,.v ke—Jk v PHONE OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR �yJ,�l1L �� PHONE 36,9-5 -z) Z, CONTRACTOR ADDRESS CITY/STATE/ZIP SS'16�44.� LICENSE qp{G-42 ❑f IC -36 OTHER NUMBER XPIRATION DATE 0 2'!!�z Z WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT ##- P ,s�105 OG y� LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION Li ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT n OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: �6 RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: i NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY A.*z" gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS WELL DISTANCE TO NEAREST: WELL /5-0 ft FOUNDATION 1O ft �y PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) �— LEACH LINES ❑ LEACHING CHAMBERS Received By <Lche Cash # OF LINES_ LENGTH OF LINES '�S ft Permit/ Service Request # DISTANCE TO NEAREST WELL ft FOUNDATION �2� 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 �t. DISPOSAL PONDS WIDTH _ ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER- 3 WIDTH L/j, /f ft DEPTH AS ft DISTANCE TO NEAREST WELL /Sv ft FOUNDATION 5-0 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. SIGNED Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS Al U 111 Sc/ -� TITLE DATE �/��8✓� ARTMENT USE ONLY /qq(.� Date 1-22 Area l Employee ID# DatelD�•ZTg ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: PE Code SC INFO Received By <Lche Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 1L �2� - 3•� -22 0l�g 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T