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-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YE&R FROM DATE ISSUED <br />JOB ADDRESS ' / (� ' CITY/ZIP_rj ?� <br />CROSS STREET �+ /C'V 1 VV� , APN 4i(3 � � PARCEL SIZE <br />OWNER NAME 7 1Jgl� <br />�e�^'Vy✓o �+ 5 PHONE <br />OWNERADDRESSPCIUX. ­11ak e,-ICIV%*A4-SCITY/STATE/ZIP <br />CONTRACTOR Oil 94S K- PHONE <br />CONTRACTOR ADDRESS <br />�J�a7•�% <br />? J <br />CITY/STATE/ZIP <br />LICENSE I I C-42 I I C-36 OTHER I01177 NUMBER & 5?9�' EXPIRATION DATE����yZ <br />WATER TABLE DEPTH: V ft GEOGRAPHICAL INFORMATION: COordin tes X Y <br />1 PERC TEST # BUILDING PERMIT # AND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION PAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br />vui-vrvonvw�.�r.r�w �raiun i UESTRUCTiON <br />INSTALLATION WILL SERVE:RESIDENCE I COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: O NUMBER IF EMPLOYEES: <br />U-0 SEPTIC TANK <br />TYPE/MFG > 'I L• <br />CAPACITY I;?'s'a gal <br /># OF COMPARTMENTS_ <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY gal <br /># OF COMPARTMENTS <br />DISTANCE TO NEAREST WELL ft <br />DISTANCE TO NEAREST: WELL Lej:jI <br />ft FOUNDATION t1n) ft <br />PROPERTY LINE iSft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />PE <br />I <br />I Ss- <br />Ue"LEACH LINES I LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL 1t1 a ft <br />FOUNDATION NJ 1 ft PROPERTY LINE 7 S' ft <br />❑ FILTER BED WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED WIDTH ft LENGTH <br />ft DEPTH <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION It PROPERTY LINE C <br />❑ SUMPS WIDTH ft LENGTH <br />ft DEPTH t <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE + 20to ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH `SANJ ft <br />DISTANCE TO NEAREST WELL ft <br />SEEPAGE PITS NUMBER 1 WIDTH. i� <br />FOUNDATION ft PROPERTY LI RONIUr..__ AIN <br />ft DEPTHt OEPARTiurft <br />DISTANCE TO NEAREST WELL_ ft <br />.11 <br />FOUNDATION ft PROPERTY LINE%S ft <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 <br />LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPEN_TION LAWS. <br />MINIMUM R ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <br />TITLE !46V% -4-f'-3 --fp f DATE —2 1 <br />a <br />SE N YApplication <br />Accepted B&,LEPARTMEWN-T <br />Date <br />Area L�� Employee ID# <br />Final Inspection By Date <br />❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Dept Ft. <br />Pit/S mp Soil Character: <br />COMMENTS <br />PE <br />SC <br />INFO <br />Received <br />B <br />he <br />Cash <br />Amount <br />emi ed <br />Date <br />Permit/Code <br />Service Re uest # <br />Invoice # <br />Permit ID# <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />