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 ADDRESSL-7 ,�;(--)T f-N-; c--r CITY/ZIP `2<i <br /> I, <br /> CROSS STREET K, �jJ APN_ V PARCEL SIZE d <br /> OWNER NAME /`-! L _j �� LW/AV PHONE <br /> OWNER ADDRESS 1 1`' n� � / CITY/STATE/ZIP <br /> CONTRACTOR �LQ�y �'�i r• PHONE <br /> CONTRACTOR ADDRESS Cf /L� 6,* 1.'So CITY/STATE/ZIP �'J���{�.:��`} �J` �S �S L• <br /> LICENSE ❑ C-42 []PC-36 OTHER NUMBER Wi�4 J�"f EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> E PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I�OJ(� OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: L I<ESIDENCE ❑ COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: i NUMBE�R OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 9---SEPTIC TANK TYPE/MFG � !i�r, 1-bAx f-./ +�� CAPACITY t&o 981 #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ` t <br /> DISTANCE TO NEAREST: WELL .! f ft FOUNDATION In f1 PROPERTY LINE -3.514ft <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 It 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 WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 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 A VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209),1953-7697 <br /> SIGNED TITLE 4f­e>-,(V� C-{,J 1- DATE <br /> EPA RTMElkSEk NLY <br /> Application Accepted B Date4:�I(q&qArea Employee ID#4A_ <br /> Final Inspection By Date ZE SPEC L PE MIT-Approved by <br /> Character of Soil to Depth of 3 Ft: I Pit/S mp Soil Character: <br /> GC/<A/L —RA1,P �r2c, <br /> TrV <br /> { C, 0 <br /> - -- -- - - <br /> PE SC ReceivedChe Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Cash Remitted Service Request# <br /> 18.E <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />