Laserfiche WebLink
+r <br /> a <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 PERNV CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS t �.� �zr CITY/ZIP S (� <br /> CROSS STREETrhu / <br /> 05 PARCEL SIZE 1 1Alm <br /> APN Id <br /> l -77 <br /> -7 �; d <br /> OWNER NAME (XV1U7 PHONE Cg 9) �!q Z -7(� <br /> ;Ty��OWNER ADDRESSIInowz� CITY/STATE/ZIP <br /> CONTRACTOR ^WU 2 Z 5Q&pF?Q PHONE L20I 222 7542!z <br /> CONTRACTOR <br /> ADDRESS CITY/STATEIZIP <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: I I ft GEOGRAPHICAL INFO ATION: COor aces X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 24 NEW INSTALLATION LI R PAIR/ADDITION LI ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: (e RESIDENCE LlCOMMERCIAL ❑ OTHER <br /> ) <br /> NUMBER OF LIVING UNITS: ( 5I F �NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> `Ii�_ SEPTIC TANK TYPE/MFGy�""Q `�+- / CAPACITY O0 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> .I� LEACH LINES �=LEACHING CHAMBERS #OF LINES A LENGTH OF LINES ft <br /> I DISTANCE TO NEAREST WELL /q0 ft FOUNDATION (23 _ft PROPERTY LINE J(/ I ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERMMENT ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH RECEIVED ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH .4-P 1 5 2018— ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH SAN JOAQUIN COUNTY ft <br /> ENVIRONIVIENTAt <br /> t� DISTANCE TO NEAREST WELL ft FOUNDATION ft PRONEAL ft <br /> ,ate SEEPAGE PITS NUMBER WIDTH f o� Q C) ft DEPTH ft <br /> DISTANCE TO NEAREST WELL�� ft FOUNDATION- ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I_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 /> UM HOUR AQVANCE NOTICE REQUIRED FOR I ECTIONS -PLEASE CALL 209 53-7697_ / <br /> SIGNED TITLE tai DATE AY7 `7> <br /> (ice <br /> _ D RTMEN E L <br /> Application Accepte y Date / Area Employee ID# <br /> / _ <br /> Final Inspection By P Date f /.'2 /7d� El SPEC AL PE MIT-Approved by <br /> Character of Soil t ep f 3 F1. Pit/Sump Soil Character: <br /> CO MENTS GC FS° d I d� 30 <br /> oa J. r 9 z'Li �o <br /> 'moi' � � � � -.� ✓ � � �� s�� <br /> PE Si! Received Check#/ Amount Permit/ <br /> ode INFO B Cash RenjWeDate Service Request# Invoice# Permit ID# <br /> t Ita 5 206 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />