Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT <br />TYPE/MFG <br />GALL (ZUJJ Jb3-/bUl FOR INSPECTIONS <br />t_XPIRES 1 YEAR FROM UATE ISSUE' <br />JOB ADDRESS ii a" <br />p ^ <br />1 " V t°'IOMLI J <br />( <br />CITY/Zip LC> <br />10J: 4S a L110 <br />CROSS STREET cE-1CA�o <br />ectr <br />- APN Vry � U6 G 2 <br />Z <br />3 PARCEL SIZE y J <br />OWNER NAME Ki4 Lc4-% _b V PVYT ]'*cq_-:LA �y PHONE <br />OWNER ADDRESS P & 8 C x 19 / CITY/STATE/ZIP LG <br />CONTRACTOR LL Ws,, Irnzr � k QlQ � T __ _ _ PHONE <br />CONTRACTOR ADDRESS PO Qo>- I L3 Lt CITY/STATE/ZIP <br />LICENSE 1_1 C-42 1k7C-36 OTHER <br />NUMBER qa►3 RiiN EXPIRATION DATE A 30,1 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: <br />❑ PERC TEST # BUILDING PERMIT # <br />TYPE OF WORK: 11 NEW INSTALLATION REPAIR/ADE <br />4 <br />Coordinates X Y <br />LAND USE APPLICATION # <br />IN ENGINEER DESIGNED/ALTERNATIVE <br />0 REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM ,< DESTRUCTION JO /) I C -- <br />INSTALLATION <br />INSTALLATION WILL SERVE: I( RESIDENCE Ll COMMERCIAL 1.1 OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />07 <br />❑ SEPTIC TANK <br />TYPE/MFG <br />_ CAPACITY <br />_ gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />_ CAPACITY <br />_ gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST <br />DISTANCE TO NEAREST: WELL <br />It FOUNDATION <br />It PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />___ ❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br />Received <br />B <br />Check#/ Amount <br />Remitted <br /># OF LINES <br />Permit/ <br />Service Request # <br />LENGTH OF LINES It <br />Permit ID# <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />It <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ElMOUNDED <br />WIDTH <br />It <br />LENGTH <br />It <br />DEPTH RF&;,ft, ft <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />It PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />A <br />DEPTH ANQ� n.., ft <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />ft PROPERTY LI 'u- ft <br />QUIN <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH E Coutdrft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LIN LTH L)ppQ,rAL ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />_ <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />It PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 20. <br />SIGNED _. TITLE DATE <br />Application Accepted 7 <br />y <br />Final Inspection By <br />Character of Soil to Depth of 3 <br />COMMENTS <br />mcry I vac vrvA. r 1 <br />14 L <br />Date �' I- ///�� Area �/ �j Employee[D# <br />Date 1—/048 I 1 SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Character: __ <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Check#/ Amount <br />Remitted <br />ate <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />y�� 1olS <br />l I Z <br />42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />