Laserfiche WebLink
t <br /> t <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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM ATEISSUED <br /> JOB ADDRESS I n ) y �� CITY/ZIP R S i i ✓ <br /> CROSS STREET <br /> h�na?�`. .� APN " 0 �� PARCEL SIZE Q P hty <br /> OWNER NAME// / / Lj-+�C •'�J(�( ('�L � PHONE �i <br /> OWNERADDRESS�j7 �+ — /"L 'VJCITY/STATEPZIP WJ r gUZ7 <br /> CONTRACTOR IM I IK2 r_')'-,C4��+ L / � �� PHONE 1-1 Gat - -��G' �✓ <br /> CONTRACTOR ADDRESS CITY/STATEPZIP P��"'. /��'� e�.�� {?S 3. i U� <br /> LICENSE ❑0C-42 ❑❑C-36 OTHER 1J� NUMBER( EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATIO Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE(APPLICATION# <br /> TYPE OF WORK: V NEW INSTALLATION ❑ R PAIR/ADDITION LJ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: - 11 NUMBER OF EMPLOYEES: <br /> �­SEPTIC TANK TYPE/MFG e^ -L- CAPACITY �T no gal #OF COMPARTMENTS':- <br /> ® GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ( � ft FOUNDATION d7 ft PROPERTY LINE <br /> Q LIFT STATION SIZE TYPE OF PUMP ® PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS { #OF LINES -3 LENGTH OF LINES SS ft <br /> DISTANCE TO NEAREST WELL 1 173k')' ft FOUNDATION I t ft PROPERTY LINE 17 ft <br /> Q FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft - PROPERTY LINE ft <br /> Q DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> 0---SEEPAGE <br /> � DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER 2 WIDTH 'j 4 t ft DEPTH`;L_5 i ft <br /> DISTANCE TO NEAREST WELL Ga_�_ ft FOUNDATION D ft PROPERTY LINE V3 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 /> MINIMUM `{ HOU .ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953- 697 <br /> SIGNED TITLE — DATEIU <br /> ` <br /> A <br /> R N O Py <br /> pR <br /> EPARTMENT US O Y n <br /> Application Accepted By Date./— Area Employee ID# �Nt <br /> Final Inspection By Date I .t/1 1/ 1 S ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to De of F Pit/SumpSoil Character: <br /> COMMENTS /r <br /> PE SC Received a Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />