Laserfiche WebLink
� 1 <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 14 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3 J CITY/ZIP Z�C4S v <br /> y <br /> � <br /> CROSS STREET APN ZS _3 "7j - 2-0 �_PARCEL SIZE <br /> OWNER NAME C/�f' I(��Y� /�1 N/ IA��- PHONE <br /> OWNER ADDRESS n CITYISTATE/ZIP <br /> CONTRACTOR hMer �eD7�wC d �e(fJV PHONE ~-7 J ys3 I ? <br /> CONTRACTOR ADDRESS 7�7 Fcnvr�cw r�/'• --�/ CITY/STATEIZIP �� J <br /> LICENSE 11❑C-42 1113C-36 OTHER A NUMBER �/ EXPIRATION DATE <br /> WATER TABLE DEPTH: G?O t ft GEOGRAPHICAL INFORMATIO : Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# t� LAND USE APPLICATION# <br /> TYPE OF WORK: U NEW INSTALLATION IF R AIR/ADDITION U ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: A RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 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 ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I$ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ` S� ft <br /> DISTANCE TO NEAREST WELLAL 1[ f FOUNDATION1r) ft PROPERTY LINE S r 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 /> l DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Ir SUMPS C7,, WIDTH 2 ft LENGTH --.Z- a ft DEPTH to ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION /6 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 WIDTH ft DEPTH ft <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 Y1HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 p <br /> SIGNED TITLE�/C9�, DATE S� O <br /> s; <br /> q <br /> T O C <br /> . DEPARTMENT SE O LY ?�� p�9�QTMq4 <br /> Application Accepted 7y <br /> Date Area Employee ID <br /> # <br /> Final Inspection By Date ! q' ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS E2WA&jdrjW5 <br /> vllck , e �� 6 I !P'-'-Cd) l: 4 <br /> PE SC Received ("ilecl Amount Permit/ <br /> Code INFO B ash emitted Date Service Request# Invoice# Permit ID# <br /> 0}2-U 5 !l <br /> 42-01 a1 � lid y�� 11-011q ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />