Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT � Le5 U � CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS TT aTY/ZIP Q Q • <br />CROSS STREET vQ I APN.�� / -(2(Li / PAHCELSIZE <br />OWNER NAME ��� �• *41 'G PHONE <br />OWNER ADDRESS <br />17 <br />//�LCITY/STATFJZIP'] C ? <br />CONTRACTOR (� Ve t&I S4�,t PHONE OO I YC 7 <br />CONTRACTOR ADDRESS di O SO ^ ' De CITY/STATEIZIP <br />LICENSE )�-42 F7, C-36 OTHER NUMBER ysfrr EXPIRATION DATE t- -1 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST 150 V BUILDING PERMIT# LAND usEAPPLICA7m <br />2 <br />2 <br />J <br />Application Accepted By <br />Final Inspection By_ <br />Character of Soil to Dept'. <br />COMMENTS [ �Y <br />vielL <br />Q <br />— <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION <br />WILL SERVE: t RESIDENCE <br />COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />CW <br />❑ <br />SEPTIC TANK <br />TYPE/MFG S'ek <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />GREASETRAP <br />TYPEIMFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />R FOUNDATION <br />ft PROPERTY LINE ft <br />O <br />LIFTSTATION <br />SIZE TYPE OF PUMP <br />❑ PKGTX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES Q / ft <br />DISTANCE TO NEAREST WELL /ro <br />ft FOUNDATION QC , <br />ft PROPERTY LINE I�OO ft <br />❑ <br />FILTER BED <br />WIDTH If LENGTH <br />It <br />DEPTH <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY UNE R <br />❑ <br />MOUNDED <br />WIDTH It LENGTH <br />ft <br />DEPTH <br />DI STANCE TO NEAREST WELL <br />it FOUNDATION <br />ft PROPERTY LINE) <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />DISTANCETo NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ftD <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft <br />DEPTH <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY UNE ft 3 <br />�J <br />y� <br />SEEPAGE PITS <br />WIDTH <br />NUMBER -3 WH_ 3& <br />if�j ft <br />DEPTH g25 , ft r <br />DISTANCE To NEAREST WELL� I <br />ft FOUNDATION b/�OT <br />ft PROPERTY LINE �O O Ib ft <br />I H ERERY <br />CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM 46 <br />HOUR ADVANCE NOTICF. REQUIRED <br />FOR INSPECU= - PLEASE <br />CALL (209) 953-769 <br />SIGNED <br />TITLE 4- <br />DATE S'-671-146 <br />2 <br />2 <br />J <br />Application Accepted By <br />Final Inspection By_ <br />Character of Soil to Dept'. <br />COMMENTS [ �Y <br />vielL <br />Q <br />— <br />7- <br />Z C J <br />M <br />O <br />I <br />Nky <br />Area Employee ID# <br />44 <br />I � SPECIAL PERMIT -Approved by ' <br />I Soil Chelactea. <br />PE SCReceived Checks/ Amount Date PeITNV Invoice III PerrnitlDs <br />Code bra Cash emitted Se Z"n nests <br />O O Loll S <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114118 <br />