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 /> Ell <br /> !fo <br /> JOB ADDRESS S—C) P�z CITYIZIP S�O C w <br /> H <br /> CROSS STREET �rV. /`1 C' /'/�1FAQ-j-/q?j Pte? APN C,C 1 V J J PARCEL SIZE �7 <br /> OWNER NAME 177L �6 t/[7V' tA-1I ��j/�(�/ PHONE y <br /> OWNER ADDRESS �J//- L/` ��W�f`� row-5-c— CITY/STATE/ZIP <br /> CONTRACTOR eoezzjC' z /���(� `S�/1{7�- PHONE Z0`7 <br /> CONTRACTOR ADDRESS /j 316 /�/Su7�� lCITYISTATE/ZIP <br /> LICENSE Opt-42 ❑❑C-36 OTHER NUMBER YS`1G/!5- EXPIRATION DATE D I <br /> WATER TABLE DEPTH:�]'r0 ?p ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L NEW INSTALLATION REPAIR/ADDITION LJ ENGINEER DESIGNED/ALTERNATIVE ` <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: W RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> (SEPTIC TANK TYPE/MFG CAPACITY / gal #OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION /y ft PROPERTY LINE 70 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SY ST EM) <br /> 7 <br /> OIL LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ,7G ft PROPERTY LINE /O ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER 9 WIDTH 3 / fl DEPTH- ,25-1 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 3 ft PROPERTY LINE / G 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 `{$HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE t DATE <br /> r <br /> rn 1 <br /> 1 c <br /> i <br /> 2A L+ <br /> DEPARTMENT SE O LY <br /> Application Accepted By Date Area Employee ID#� <br /> Final Inspection B Date �/ �! L`'j ❑ SPEC L PERMIT-Approved b <br /> p Y pp Y <br /> Character of Soil to Depth of 3 Ft: PitlSump Soil Character: <br /> COMMENTS <br /> PAYMENT <br /> RECEIVE® <br /> PE SC Received Checic#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Re uest# Invoice# I. r iT�ID�o�� <br /> o 3 I I 9 1� 0077'W1 <br /> NZY <br /> IRONur%wNM- - <br /> HEALTH DEP <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />