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 YEAR FROM DATE ISSUED <br /> JOB ADDRESS33 YO C. Q CITY/ZIP I v � <br /> ^ / H <br /> CROSS STREET "{3 M0 Itit J APN Or 3A10S!j PARCEL SIZE Y <br /> 0 <br /> 0 <br /> OWNER NAME Da PHONE <br /> y <br /> OWNER ADDRESS CITY/STATE/ZIP 2 ` <br /> CONTRACTOR 64144r4I II ••C PHONE do q —3Cca 1''� <br /> _ 7 O� /(� <br /> CONTRACTOR ADDRESS (� /JOyj dI CITYISTATE/ZIP Lodi% ('4 <br /> LICENSE ❑A-42 ❑]C-36 OTHER NUMBER EXPIRATION DATE I-.7) ^j / <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ] ENGINEER DESIGNED fl IplLTERN TIV �j <br /> kr <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION 7rN <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG LO CI•�;& !'� CAPACITY I V oD gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL So ft FOUNDATION S ' ft PROPERTY LINE ? ' It <br /> O LIFTSTATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> �( DISTANCE TO NEAREST WELL R ' FOUNDATION ft PROPERTY LINE <br /> _ ft <br /> Wt <br /> FILTER BED WIDTH I rJ 1 ft LENGTH tl*J I DEPTH DO WWe- ft <br /> / DISTANCE-'•"AREST WELL Sa f ft —INDATION P—.—Imp 1Q ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE H ! DATE C2-/57-/C/ <br /> AYMENT <br /> Q r COUNTY ECEiVED <br /> ar ,.A7 <br /> HPF EB 15 2019 <br /> CANJOAQUIN COUNTY <br /> NVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> DEPARTMENT U E O LY <br /> Application Accepted By Date Area 1 Employee ID# 7�( <br /> Final Inspection By ly Date 7-1 ZVI 20 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pintts S�V'I Charact <br /> COMMENTS <br /> PE SC Received Check Amount Date Perm tt Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Re uest# <br /> 11 <br /> 3oo AHWI GC <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />