Laserfiche WebLink
Mc(( +I }iflQ� <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT L:ALLN'J rJ9:f-/b`J/ FOR INSPECTIONS tXPIRES l YEAR FROM DATE ISSU <br />JOB ADDRESS 33 ON CITY/ZJP <br />CROSS STREET _ Com. yVt�-s� e APH V _/L.S U 3 D PARCEL SIZE <br />OWNER NAMEV. �C. LJ -^ P Q / W ' I 1 UI r G �_ ILMPIKINE ;0 9 q70 -0& <br />OWNER ADDRESS % CITYISTATE_MP <br />CONTRACTOR /��dr&?'11 I�4/ dO;C PHONE <br />34 17 <br />CONTRACTOR <br />CONTRACTORADDRESS 93(Ce <br />CITY/STATE0P/f, <br />LICENSE nC-42 C-36 OTHER _ NUMBER � a EXPIRATION DATE Tj�/ <br />PERC TEST w <br />TYPE OF WORK: <br />FBURRING PERMIT # <br />NEW INSTALLATION <br />REPLACEMENT <br />LAND USE APPLICATION # <br />REPAIR/ADDmoN ENGINEER DESIGNED /ALTERNATIVE <br />OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: REB. <br />COMMERCIAL Prr <br />OTHER <br />DEPTH It <br />C <br />Z� Z � <br />ZD <br />_ <br />CC n, r4tN Y^I11WMBER <br />NUMBER OF LONG UNITS: i NUMBER OF BEDROOMS: <br />OPEMPLDYEES: <br />❑ SEPTICTANK <br />TYPE/MFG W <br />CAPACITY <br />gal #OFCOMPARTMENTS <br />❑ GREASETRAP <br />TYPEIMFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />. DEPTH It <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LIES X LEACHING CHAMBERS # OF LINES 4- LENGTH OF LINES go R <br />DISTANCE TO NEAREST WELL t70 ft FOUNDATION ;IL5' , ft PROPERTY LINE S"a , ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH It <br />C <br />Z� Z � <br />ZD <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />. DEPTH It <br />DISTANCE TO NEAREST <br />I <br />WELL <br />R PROPERTY LINE ft <br />SUMPS �p�) <br />WIDTH [� <br />ft LENGTH �7 <br />,,R//FOUNDATION <br />r <br />ft <br />DEPTH47 ft <br />DISTANCE TO NEAREST <br />WELL ' <br />It FOUNDATION &0 1 ft PROPERTY UNE :P Q f It <br />❑ <br />DISPOSAL PONDS WIDTH <br />ft LENGTH <br />It <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY UNE ft <br />❑ <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />I HEREBY CERTIFYTHAT 1 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 />DATE r7 1O !lv <br />Application Accepted By <br />Final Inspection By <br />Character O1 Soil to De <br />COMMENTS <br />Area <br />b jf ❑ SPECT_ALL PERMIT <br />PItG mIp Soil Character: <br />Employee ID# �U <br />Approved by <br />PE SC Received Check#/ Amount Date PermiV Invoice # Permit ID# <br />Code INFO BY Cash Remitted Service Request IT <br />1.1 i 1 66 36 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />.1 <br />lu <br />LLI <br />o <br />tom. <br />C <br />Z� Z � <br />ZD <br />aaw <br />wT <br />Application Accepted By <br />Final Inspection By <br />Character O1 Soil to De <br />COMMENTS <br />Area <br />b jf ❑ SPECT_ALL PERMIT <br />PItG mIp Soil Character: <br />Employee ID# �U <br />Approved by <br />PE SC Received Check#/ Amount Date PermiV Invoice # Permit ID# <br />Code INFO BY Cash Remitted Service Request IT <br />1.1 i 1 66 36 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />