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-REFUNDAj3LF-PERNUT CALLf209).953-7697 F-OR,(NSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />P <br />CROSS STREET \- - A9, (� —APN Obi I-- O ` r, - O L 0 PARCEL SIZE7,650 <br />OWNER NAME_�� 1LLM to CA [j.0 -,-.V T1/r�//UVJ 1 l//Z'S C5 1 � �--� /►PHHONE 3$ J C6 4= <br />OWNER ADDRESS .4� U2- VVV fW CITY/STATE/ZIP 1, po l <br />CONTRACTOR �• /�1•� �'i�'�ln�'W � }�� �'�SCt--yJ�` �JC- PHONE4-66n6(0 C�� <br />CONTRACTOR ADDRESS -1 IJLAJ Iv + 111/L1/��J(�/ `^�'�_ 1 C CITY/STATE/ZIP( Y 2Z'5 <br />LICENSE X C-42 C-36 OTHER A NUMBER J EXPIRATION DATE , LL� I �1 <br />WATER TABLE DEPTH: �� ' lI ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ <br />PERC TEST # BUILDING PERMIT # <br />Check#/ <br />as <br />LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED/ALTERNATIVE <br />Permit ID# <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />❑ COMMERCIAL �% <br />❑ OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: ` <br />NUMBER OF EMPLOYEES: <br />11 <br />SEPTIC TANK TYPE/MFG �! 1� <br />CAPACITY <br />O gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />LIFT STATION SIZE TYPE OF PUMP <br />O PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />FILTER BED WIDTH ft LENGTHft <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />pQ <br />LINE ft <br />'A`[ft rw <br />ElMOUNDED <br />WIDTH ft LENGTH <br />ft RG�DL�P�ift <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />��Eft� PRf��j�BTY LINE ft <br />❑ <br />SUMPS WIDTH ft LENGTH <br />) <br />ft6-rDAT� LLuu Q ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />_ . „ fSAQUItPINE ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft ENVIRONMENTAL ft <br />DEP ENT <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />HEALf OPERTY LINE ft <br />❑ <br />SEEPAGE PITS NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE 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 LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 <br />COMMENTS 77C -Z-11 <br />�K— 7'--,"k <br />Area l <br />❑ SPE <br />Pit/Sump Soil Character: <br />P Employee ID#� <br />ERMIT - Approved by <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ <br />as <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />0 <br />z- <br />42-01 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />T <br />