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 ADDRESS 1 �/��SUtti CITY/ZIP Ll)• ? v <br /> CROSS STREET ,Y+CJ���)� � APN r7—j-AQ 2f PARCEL SIZE 1 y <br /> c <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP// <br /> CONTRACTOR ^7 /L� PHONE 6— X027 <br /> CONTRACTOR ADDRESS / -U v CITY/STATE/ZIPS <br /> LICENSE ❑❑I -42 ❑LIC-36 OTHER NUMBER L/S�1�i'S- EXPIRATION DATE d//3✓//y <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 i_I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: r24,RESIDENCE ❑ COMMERCIAL E 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 /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES yO ft <br /> DISTANCE TO NEAREST WELL -,&V' ft FOUNDATION It 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 /> I�- SEEPAGE PITS NUMBER WIDTH, �3 ft DEPTH '�S ft <br /> DISTANCE TO NEAREST WELLIO <br /> ft FOUNDATN O ft PROPERTY LINE ov ft <br /> — F�' 'L>k4 TTG' ►A <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 /> MINI M 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECT ONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE G DATE G <br /> T <br /> E V <br /> Wlj/tVCCU4TY <br /> HDER41L <br /> T <br /> EPARTMENT USE ONLY <br /> Application AcceptedB Date Area l Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to lDeepth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS OK �0 4 1i' 100' SE P_cyn4 y,, Ge�ueean Di+ 4- WPJI <4rm cal cis"' S r— <br /> PE SC Received C Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> l to l S(1 �2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />