Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-KEFUNDABLE PERMIT GALL (2U.9).953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB AD SS y� n CITY/ZIP C_�/ 77-5-2,o f �/J <br />GROSS STREET " t '�-/ APN D ` 1 I 1 (0(,Za *2 PARCEL SIZE �•/ \ 1 <br />OWNER NAME d�f <br />`PHONE <br />OWNER ADDRESS CITY/STATE21P 4l/�9 <br />nnj �CONTRACTOR OJ �22' _uI___ <br />O� <br />CONTRACTOR ADDRESS <br />LICENSE ❑ F C-42 Eli C-36 OTHER <br />CITY/STATE/ZIP <br />NUMBER EXPIRATION DA <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />I_j PERC TEST # BUILDING PERMIT # 0 q—Ulrn 1%3q LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED_ /ALTS ,NATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION S�n' f AV— <br />INSTALLATION WILL SERVE: F, RESIDENCE Ll COMMERCIAL U OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />LEACH LINES <br />'I LEACHING CHAMBERS <br />Received <br />B <br />C eck#/ <br />��O <br />DISTANCE TO NEAREST <br />WELL <br />Permit/ <br />Service Request # <br />FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />I <br />MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />SUMPS <br />WIDTH <br />ft <br />LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />DISPOSAL PONDS <br />WIDTH <br />ft <br />LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />SEEPAGE PITS <br />NUMBER <br />WIDTH_ <br />DISTANCE TO NEAREST <br />WELL <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br /># OF LINES <br />ft FOUNDATION <br />ft <br />ft FOUNDATION <br />ft <br />ft FOUNDATION <br />ft <br />ft FOUNDATION <br />ft <br />ft FOUNDATION <br />ft FOUNDATION <br />LENGTH OF LINES _ <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <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 AD CE NOTICE REQUIRED F04,INSPECTIONS - PLEASE CALL 9 953-7697 ) <br />SIGNE� � �- ��� TITI-DATE34 <br />DEPARTMENT USEONLV <br />Application Accepted By Date d_►_ Area -ad OLA Employee ID# �uo1Ai <br />Final Inspection By Date Z -Z,4'1O ❑ SPECIAL PERMIT - Approveu by <br />Character of Soil to Depth of 3 Ft: If Pit/Sump Soil Character: <br />COMMENTS QjA.Aa_.-CA IhAA�va.1 Tix.wlll2 D1'Ea.f "-,, .Cl,<A.�04 I%P—t-161q,3� <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />C eck#/ <br />��O <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />I <br />Coc's <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />17 <br />.j <br />Y <br />z <br />m <br />