Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P / -'SAN •JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CA 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 1KOAD 0040"LAW>CITY/ZIP CAViNj Z O <br />CROSS STREETLT-H <br />SEPTIC TANK TYPE/MFG <br />1 L� <br />N110 -V J PARCEL SIZE _1_7" / r 1 <br />AAP ) _�� <br />OWNER NAME <br />CAPACITY _ gal # OF COMPARTMENTS <br />Permit/ <br />Service Re uest # <br />Pi PHONE -I dn -~ 3 0 <br />OWNER ADDRE <br />a <br />LIFT STATION SIZE TYPE OF PUMP <br />_ _ _ It �/t-��_ _ <br />_CITY/STATE/ZIP <br />SC <br />CONTRACTOR ( <br />AD <br />­PHONE '4-66~ <br />�7 "F <br />00 W <br />DISTANCE TO NEAREST WELL <br />AlD" <br />CONTRACTOR ADDRESS <br />FILTER BED WIDTH ft LENGTH <br />I, <br />CITY/STATE/ZIP <br />LICENSE A I C-42 ❑ <br />_'C-36 OTHER_ <br />❑ <br />NUMBER A()C)S1!_ EXPIRATION DATE Vt <br />ft DEPTH ft <br />DISTANCE TO NEAREST ,WF,CL <br />V <br />It FOUNDATION ft PROPERTY LINE L-fC <br />WATER TABLE DEPTH: <br />ft <br />GEOGRAPHICAL INFORMATION: Coordinates X _ Y <br />❑ PERC TEST # <br />t T <br />FOUNDATION ft PROPERTY LINE ft <br />BUILDING PERMIT #_ _ LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />_1 REPAIRIADDITION 11 ENGINEER DESIGNED/ALTERNATIVE <br />ft FOUNDATION ft PROPERTY LINE ft <br />REPLACEMENT <br />SEEPAGE PITS NUMBER WIDTH <br />I I OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL 2 ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: <br />❑ <br />SEPTIC TANK TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP TYPE/MFG <br />CAPACITY _ gal # OF COMPARTMENTS <br />Permit/ <br />Service Re uest # <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION _ ft PROPERTY LINE ft <br />❑ <br />LIFT STATION SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />�tS <br />LEACH LINES LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES ft <br />�7 "F <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />Q <br />FILTER BED WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />MOUNDED WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST ,WF,CL <br />V <br />It FOUNDATION ft PROPERTY LINE L-fC <br />SUMPS WIDTH 4 ft LENGTH <br />DEPTH ft <br />DISTANCE TO NEAREST WELL In rft <br />t T <br />FOUNDATION ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL _____ <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />SEEPAGE PITS NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION <br />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 <br />STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORK <br />E S COMPENS ION LAWS. <br />CE REQUIRED FOR ESE CALL 209 �-77�� <br />elf <br />` <br />\ . <br />�10S <br />TITLE DATE <br />001 <br />vppiicaiion Accepted By to Area 17101 <br />Final Inspection By Date C! SPE IAL <br />Character of Soil to Dep of 3 _ _ Pit/Sump Soil Character: —i <br />COMMENTS <br />T <br />W Employee ID# 010" <br />IT - Approved by ` <br />PE <br />Code <br />SC <br />INFO <br />Received <br />Cash <br />Amount <br />Rem'tt d <br />Date <br />Permit/ <br />Service Re uest # <br />Invoice # <br />Permit ID# <br />Kra <br />42-G? <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />