Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 1 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT <br />JOB ADDRESS 35 <br />CROSS STREET ^ // ` <br />OWNER NAME nX19r I es <br />OWNER ADDRESS <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />GALL <br />YbJ-/65/ FOR INSPECTIONS <br />CITY/ZIP ^ <br />n ^ <br />S 1 YEAR FROM DATE ISSUEI <br />J' <br />PARCEL SIZE <br />LICENSE [I 'C-42 I I' C-36 OTHER __ <br />PHONE <br />CITY/STATE/ZIP <br />NUMBER _ _ _ EXPIRATION DATE _ <br />WATER TABLE DEPTH: _ ft GEOGRAPHICAL INFORMArION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION #_ <br />TYPE OF WORK: L NEW INSTALLATION REPAIR/ADDITION ENGINEER DESK <br />TERNATIVE // <br />REPLACEMENT t 1 OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION lc— <br />INSTALLATION WILL SERVE: ❑ RESIDENCE LI COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL _ ft FOUNDATION _ ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br />Received <br />By <br />Check#/ <br />Cach <br /># OF LINES <br />Date <br />LENGTH OF LINES <br />ft <br />Permit ID# <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />� <br />_ ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />_ <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH <br />_ ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />_____ <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH _ <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />It DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />_ 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 />NON M�■■■■il■■t�! � �,�/■■�■■■■■■■■■■Z�L�11/1,■.'1.11,-', �!!�■■■■■ <br />1■■■■■I■i��■■iiiiiiiii■■it■■.!l�.71�■71t111'I`i�l►�■■■■■ <br />..0����I.�■S■■■■■■■G■fi1�■r■■■■■■■■■■■ <br />NON MIN ■■■It■■■■■■M■■■■■■■■■■■■■■■■■■■1111■■■■ <br />■■■■■�i■■■■11■■1111■■1111■111111■■11■■1111111111■■■■���■■■11 <br />■■■■■:I■■■■11■!!�! TIT■A■11■■■■■■■■■■■■■■I:\ �I ►'i f'li■■■ <br />mom 11RISE ■■■w■■lildT�:!'���',7■■■ <br />ENE ■\ilMEMO \■■■■■■■■■11■ ■1111■■ mom ■11■11iir■�ANNE <br />■■■■�ININE ■11111111 11111:!■!!1111■■■■■■■■■■■■momFlo,01. 011■ <br />■■11■■■■■■■■■■■■r11■■■111111■11■111111■rr■■�■■■ <br />■■11■■�11■■■■■■■■111■■■■■■11■■111111■■■■■■' �'i��ii1111 <br />■■■■11111■■■■■■■11 ■■■■■ MI11■■ <br />■■■■1�►1111■■■■■■■■■■■■■■11■■■11■0■■■■■■■■■■■■■■11■ <br />■■■■■��■■■■■■■■N■■■■■■■■■■■■■■11■■■■11■■1111■■■■■ <br />■■■■■I■■■■■■■f/J■■■■■■■■■■11■■■■■■■■■■■■■■■■■■ <br />Final Inspection By Ai gr <br />MEMBER 01 <br />PE <br />Code <br />Sc <br />INFO <br />Received <br />By <br />Check#/ <br />Cach <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />©7 <br />! ZZ"" <br />� <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />