Laserfiche WebLink
• • i ONSITE WASTEWATER TREATMENT SYSTEM PERMIT Pv�' <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 YEAR FROM DATE ISSUED <br />JOB ADDRESS/ 3 w1' r CITY/ZIP /ted/. Ir <br />CROSS STRE <br />OWNER NAM <br />�APN <br />OWNER ADDRESS <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />LICENSE L_ X-42 r1 C-36 OTHER <br />PARCEL SIZE <br />I ,TPHONE <br />ITY/STATE21P <br />PHONE_ <br />CITY/STATE/ZIP <br />NUMBER ( EXPIRATION DATE / — 21 — / <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />I I PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION X REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: �) X RESIDENCE LI COMMERCIAL LI OTHER <br />NUMBER OF LIVING UNITS: y NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ <br />ey'61kArl <br /># OF LINES LENGTH OF LINES LLn <br />'7— , ft <br />ash <br />SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS C2 <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />DISTANCE TO NEAREST: WELL ft <br />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 />SIGNED <br />Application Accepte� <br />Final Inspection By PG <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br />i <br />ieM■■ll•MM■Emom <br />DEPARTME N Y <br />Date Yj IAretPqEIAL <br />Employee ID# <br />Date ❑ PERMIT - Approved by <br />Pit/Sump Soil Character: <br />je V- <br />rM'k►� <br />PE <br />Code <br />LEACH LINES I LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES LLn <br />'7— , ft <br />ash <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION (0-0 ft PROPERTY LINEO 'S ft <br />❑ <br />FILTER BED WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ <br />MOUNDED WIDTH ft LENGTH <br />.e <br />ft DEPTH NT <br />C <br />DISTANCE <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE <br />❑ <br />SUMPS WIDTH ft LENGTH <br />ft DEPTH �-�—.— ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE t <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH SAN,1f%A ... _ ft <br />DISTANCE To NEAREST WELL ft <br />FOUNDATION ft PROPERTY LIN6,_EM/►R0 M .��wy <br />SEEPAGE PITS NUMBER J WIDTH 3 <br />ft DEPTH �rt��H DE <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION QO ft PROPERTY LINE 80 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 A14D REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENEjkTION LAWS. <br />MINIMUM 1f HOUR ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <br />Application Accepte� <br />Final Inspection By PG <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br />i <br />ieM■■ll•MM■Emom <br />DEPARTME N Y <br />Date Yj IAretPqEIAL <br />Employee ID# <br />Date ❑ PERMIT - Approved by <br />Pit/Sump Soil Character: <br />je V- <br />rM'k►� <br />PE <br />Code <br />Sc <br />INFO <br />Receivedec <br />By___ <br />ash <br />Amount <br />Remitted <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />-73 0 <br />� <br />I;LY5 <br />C <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />