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 Har <br /> CALL 209 953-7697 FOR INSPECTIONS EXPI <br /> RRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 12- <br /> 62S0 L: ne.1(,,� CITYIZIP J YU <br /> CROSS STREET PARCE�L SI�ZEY <br /> OWNER NAME wQ� to <br /> �y1 � �C1 <br /> OWNERADDRESS - as 11 ! Uki CITYISTATE/ZIP Lad'. CA- 9S`4T <br /> b <br /> � <br /> CONTRACTOR &J41 PHONE ("("rw,�- <br /> CONTRACTOR ADDRESS SA�^e CITY/STATE/ZIP <br /> LICENSE ❑❑C-42 ❑11C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION LI REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: r NUMBER OF BEDROOMS: /�� NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY LV0 gal #OFCOMPARTMENTS1z_ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ` <br /> ft FOUNDATION ft PROPERTY LINE /() 1� ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 NUMBS WIDTH aL 1, 0ft DEPTH % L ft <br /> DISTA E T NEAREST WELL ft FOUNDATION -F ft PROPERTY LINE T ft <br /> I HERE CERTIFY THAT I HAVE EPA D 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 /> INIMUM qj OU AD NCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (2Q9),953-7697 <br /> SIGNED TITLE DATE rD <br /> Air <br /> r <br /> 0 <br /> F N <br /> B PARTMENTU E N Y <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By GL l QQ6-' Date f���ur 1� ❑ SPECIALP RMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Amount D to Permit/ Invoice# Permit ID# <br /> Code INFO a mitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />