Laserfiche WebLink
e <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 <br /> QPERMIT �l CALL 209 953-7697 FOR INSPECTIONS , w EXPIRE <br /> ,IS 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS p 7t/ (_LaVE2 CITY/ZIP Tl-.•4CV [iii 7 E?0� <br /> n <br /> CROSS STREET `U2 R A L f}OL110IN/ A P N �- /a -a2 Go- 6 PARCEL SIZE O ( I p <br /> O <br /> A <br /> OWNER NAME ���Qu I�L 4A LVA Al PHONE C;L 01 - 34 <br /> n p U <br /> OWNER ADDRESS 11970 �' (��LC,U�/t CITY/STATE/ZIP 7—,eA L���t]O•� <br /> CONTRACTOR 1�(E S N /(LAJS u.4--r,t j4 PHONE �(I (JZ ((,- S-7 <br /> CONTRACTOR ADDRESS P G O x 3:7!14 CITY/STATE/ZIPQ L� G A 1 S3B l <br /> LICENSE ECIC-42 1_1 C-36 OTHER RCE 75479 NUMBER EXPIRATION DATE 613011-1 <br /> WA <br /> T TABLE DEPTH: �"X02 ft GEOGRAPHICAL INFORMATION: Coordinates X r Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: F RESIDENCE 7 COMMERCIAL I 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 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 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 /> MIN"U 48 HOU ANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE ��✓/L EN�/M,E,6Z e DATE 7 '_- / <br /> 7T Vol: <br /> L <br /> p S iV JOQWNC U TY <br /> T <br /> -� DEPARTMENT USE ONLY nn <br /> Application Accepted B Date Area Employee ID# !J <br /> SPE("IAL PERMI - <br /> Final Inspection By Date _ Approved by <br /> Character of Soil to Depth,gf 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS ►�dl <br /> ala �n r�.-E�., �2• ���_���► --- <br /> PE SC Received heck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO ash Remitted Service Request# <br /> 5 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />