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 j / EXPIRES 1 YEAR FROM DATE ISSUED <br /> Z <br /> JOB ADDRESS �Co��� GcuGiJS� //=eC ��'C CITY/ZIP ' C<- Z' <br /> H <br /> CROSS STREET 4/[Jz�G -� APNO-4;14W —qZ PARCEL SIZE b_ a <br /> OWNER NAME �h.��/ /J�O�I�JGI�KJ SPHONE <br /> A <br /> OWNER ADDRESS S�1✓h 't- fP0 poky/ <br /> oy CITY/STATEIZIP <br /> CONTRACTOR PHONE / <br /> CONTRACTOR ADDRESS i� ���i D�S�'W I7� l> CITY/STATEIZIP <br /> LICENSE Pgfil--42 ❑❑C-36 OTHER NUMBER `�. Ot��EXPIRATION DATE <br /> i <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFO RMATIO : Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION LI R PAIR/ADDITION Li ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: JX-RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: I- NUMBER OF EMPLOYEES: <br /> Q <br /> fA SEPTIC TANK TYPE/MFG l I'L CAPACITY l��U gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL /00 ft FOUNDATION 5— ft PROPERTY LINE 1W -L 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 S� ft <br /> DISTANCE TO NEAREST WELL JUG ft FOUNDATION '-�PO ft PROPERTY LINE lG0 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 -7 ft FOUNDATION ft PROPERTY <br /> LINE ft <br /> SEEPAGE PITS NUMBER :�L WIDTH J ft DEPTH O S ft <br /> DISTANCE TO NEAREST WELL /SO' ft FOUNDATION J00"5-0, ft PROPERTY LINE /C� 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLES DATE h'��slry <br /> j <br /> rfi <br /> 9 <br /> NT <br /> :EAFED <br /> 0 <br /> �I 2019 <br /> J QU N COUNTY <br /> TAL <br /> TMENT <br /> EPARTMEN SE N Y <br /> Application Accepted BDate Area Employee ID# <br /> Final Inspection By Date ❑ SPECI L PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: <br /> COMMENTS <br /> �r - <br /> PE SC Received Check# Amount Permit/ <br /> Code INFO B ash emitted Date Service Re uest# Invoice# Permit ID# <br /> J� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />