Laserfiche WebLink
1 I <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 PE MIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> OB ADDRESS ` 0 Y�C\\ IITYY/Zlp 5-t-MtAT11Av <br /> ROSS STREET V9 WI6 ls�,' { `U� APN /�-124 -r 1 PARCEL SIZE . p <br /> OWNER NAME ` 'YttONE 2CG A-'(�1 U' tLQ(0 v <br /> 1 <br /> OWNER ADDRESS nko ITY/STATE/ZIP` �S )( k '- C� OA !5�zG — <br /> CONTRACTOR t1krHONE <br /> CONTRACTOR ADDRESS ITY/STATE/ZIP �1S'LOS- <br /> LICENSE ❑CC-42 I I C-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 REPAIR/ADDITION ENGINEER DESIGNED/ LTERN VE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 01 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 44 SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> - GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ILEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEf:A It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH 0 5 7/11n ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT t — ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH EAIVI IN Cqy�_DUALS It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLIN OEP AL It <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 THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR IN ECTIONS-PLEASE CALL 209 53-7 97 <br /> SIGNE TITLE , w '"l DATE 5 5 I <br /> ItD PARTMENT ils N Y <br /> Application Accepted y Date Area Employee ID#� <br /> Final Inspection By Date 0 4 ❑ SPE ALP MIT-Approved by <br /> Character of Soil to Depth of 3 F- Pit/Sump Soil Character: <br /> COMMENTS L�i� �'a(r19��I2 <br /> PE SC Received Cheek Amount Permit/ <br /> Code INFO B ash emitted Date Service Request# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />