Laserfiche WebLink
� f <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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> '7 �c4�^ w <br /> JOB ADDRESS !f��} � ^ � \��s CITY/ZIP <br /> CROSS STREET v l7 `� p APN Z1<11? ` DO ryPARCEL SIZE( p <br /> (/1✓� �C es �T PHONE (i D�� �� 6 <br /> OWNER NAME <br /> OWNER ADDRESS z �/� � '�'r` CITY/$TATE/ZIP C-R' <br /> CONTRACTOR 12\�' , (�, PHONE L?( 2 2/ <br /> CONTRACTOR ADDRESS `1 J l VJ��� v�G�� \`fie `Ck^D ('CITY/STATE/ZIP ` ��^L �C S3(z)`q <br /> LICENSE ❑ C-42 111IC-36 OTHER NUMBER n6 EXPIRATION DATE 1 l /:?O 2(DZ C/ <br /> WATER TABLE DEPTH: t7f'- 57 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> I REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE j W rM ❑ COMMERCIAL C OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 4-1-SEPTIC TANK TYPE/MFGCAPACITY © O gal #OF COMPARTMENTS 2 <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 /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES / O� ft <br /> F <br /> !' DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE t' 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 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 48 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE e C C DATE ZG ` <br /> -8-tPARTMENT USE O LY (j � <br /> Application Accepted By Date Area -1 Employee ID# L� <br /> Final Inspection By Date C SPECIAL PERMIT-Approved by <br /> Character of Soil to De th of 3 Ft: it/Su II Character: _ <br /> COMMENTS �Z� �P_scan (�+m i�� S� APAIr S n Addrpcs Z5 ZZ sem <br /> PE SC Received Ch Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> 42-01 RECEIVED ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br /> JUN 10 2019 <br /> SAN JOAQUIN COUNTY <br /> L��ENVIRONMENTAL <br /> L pu T..-- <br />