Laserfiche WebLink
ONSITE WASTEWATER MhTMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 9 3-7697 FOR INSPECTIONS EXPIRES1 YEAR FRO ATE ISSUED <br /> JOB ADDRESS n/' �p��'Q CQ C•/�CITY/ZIP S ltlnf�- l �' <br /> CROSS STREET `O ` ��6G�,I �� APN E ga00 a7 <br /> PARCEL SIZE /S���C p <br /> OWNER NAME /��(, W rA-�S �^� PHONE /3. /c&- <br /> CONTRACTOR <br /> i�� / l� <br /> OWNER ADDRESS 2 z /?^ / s / NQS � V CITY/STATE/Z1P 5-7�DG" .c&- <br /> CONTRACTOR /VO k l PHONE / <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑IIC-42 ❑❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ii REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERN TIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM X, DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTICTANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gel #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION it PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLWES LENGTHOFLINES 1t <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it - PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it <br /> ❑ SUMPS WIDTH it LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it - PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI UM424,HDUR ADVANCE NOTICE REOUIREa FOR IN CTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED T E ��✓�` .DAT <br /> n <br /> 6 <br /> t <br /> rl <br /> o IP <br /> DEPARTMENT U ONLY ''yyQQQQ HF-A►1 ,/� <br /> Application Accepted B Date Area�""i-/--'–`— Employee ID# C 5c-6t T <br /> Final Inspection I Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS (2Lv1w Lc / <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> ZZl D 1 ioS,uo t) S° -7/9-0(p 9 RDU7S2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />