Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P v <br />GAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS - �XPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS _ <br />CROSS STREET _ <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />/ CITY21P`-�LVi%�� [�/moi/ �il_ >­t'i <br />APN M305 0.70 PARCEL SIZE <br />PHONE— 1424-7— <br />CITY/STATE/ZIP <br />PHONE 6f L>// <br />CONTRACTOR ADDRESS z4=_:2 1 CITY/STATE/ZIP '✓�A�.7yli C/y,A ! f__2' <br />LICENSE b- C-42 ❑ C-36 OTHER A / NUMBERXPIRATION DATE��! <br />WATER TABLE DEPTH: <br />I V It GEOGRAPHICAL INFORMATION: Coordinates X Y <br />n PERC TEST # <br />BUILDING PERMIT # _ LAND USE APPLICATION # <br />TYPE OF WORK: <br />OPIZNEW INSTALLATION I REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br />Invoice # <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION <br />INSTALLATION WILL SERVE: 66AESIDENCE L) COMMERCIAL I I OTHER <br />�j <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 5 NUMBER OF EMPLOYEES: <br />g SEPTIC TANK <br />T <br />TYPE/MFG j'� CAPACITY lQ gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY I gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL o11� ft FOUNDATION ft PROPERTY LINE � 7 ft <br />❑ LIFT STATION <br />SIZE _ TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />I LEACHING CHAMBERS����yy # OF LINE __ LENGTH OF LINES ft <br />DISTANCE To NEAREST WELLA' P ft FOUNDATION -Z; __ft PROPERTY LINE �i ft <br />❑ FILTER BED <br />WIDTH _ ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH ft LENGTH ft DEPTH EIIIe+.- ft <br />DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE i T -,-ft <br />❑ SUMPS <br />WIDTH ft LENGTH ft DEPTH J 4 ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY L J ft <br />❑ DISPOSAL PONDS <br />WIDTH _. ft LENGTH ft DEPTH HE Vlh'ON� L-.'_ 7Y ft <br />SEEPAGE PITS <br />�1 <br />DISTANCE TO NEAREST WELL ft F Uf�p/STION ft PROPERTY DSPAWTL 1. - ft <br />NUMBER WIDTH �— It DEPTH �b� ft <br />(/ v <br />l ' f y <br />DISTANCE TO NEAREST WELL -1, ft FOUNDATION117 ft PROPERTY LINE ft <br />I HEREBY CERTIFY <br />THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY <br />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 />MINIM <br />24 HOUR ADVA CE NO CE REOUI ED FOR INSPECTIO S - PLEASE CALL 209 953-7697 <br />�� <br />SIGNED <br />TITLE DATE ,Z/� <br />DEPARTMENTUSE <br />Application Accepted Date <br />Final Inspection By Date <br />Character of Soil to Depth of 3 Ft: PiU u <br />r <br />COMMENTS _ <br />AreaEmployee ID#� <br />�- I <br />_ ❑ SPECI�IT A y <br />roved <br />Soil Character: <br />PE <br />Code <br />SC <br />INFO <br />Received Check# <br />s <br />Amount <br />Remitted <br />Date <br />i <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />Q <br />' <br />42-01 <br />5/5/17 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />