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 2,009)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS _�sz ��P_l�r�.��� F�C CITYIZIP SIEU <br /> y <br /> CROSS STREET y< APIN ( O PARCEL SIZE Yi d <br /> d <br /> �t l '�1 / 77 <br /> OWNER NAME/T/��//gyp: i recd rk-" > 1cVSe PHONE N <br /> OWNER ADDRESS PO/-t e CITYISTATE/ZIP ��Ch <br /> CONTRACTOR _ertrz iJOfi i S' ✓/Ji L PHONE :76'1 <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP Lii L� <br /> LICENSE 0*_--42 ❑❑C-36 OTHER NUMBERVyS lr.`/5- EXPIRATION DATE 0%/_-?/Ml <br /> t <br /> WATER TABLE DEPTH: �b,ly ft GEOGRAPHICAL INFORMAON: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#PA <br /> TYPE OF WORK: ❑ NEW INSTALLATION LI R PAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF ZDRP.JXSJNUMBER OF EMPLOYEES: <br /> SEPTIC TAN TYPE/MFG n/ CAPA gal #OF COMPARTMENTS <br /> GREASE TRAWL) TYPE/MFG CAPACITY, •��� gal #OF COMPARTMENTS <br /> v 117 DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> l� LIFT STATION SIZE �'1 TYPE F UMP L3PKG TX P ANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> uykt- <br /> rDt Vit, <br /> ✓✓✓❑��` LEACH LINES ❑ LEACHING&AMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO N AREST WELL ft FOUNDATION ft PROPERTY <br /> LINE '/ ft <br /> FILTER BED WIDTH ft LENG (DO ft DEPTH�=�� ft <br /> ,\ DISTANCE TO NEAREST WELLW42 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft ENGTH 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 <br /> INE ft <br /> L� SEEPAGE PITS NUMBER 9/ WIDTH b ft DEPTH f5� 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 /> MINI OH UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED �- -�—� TITLE ��Wy 13-�f- DATE <br /> IVNT <br /> A. <br /> FO <br /> 2019 <br /> D F Y <br /> ENT <br /> EPARTMENT 10 SE NLY <br /> Application Accepted Date Area Employee ID# <br /> Final Inspection By 4e-4-- Date ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to D pth of 3 Ft: Pit/Sum Soil Character: <br /> COMMENT <br /> v <br /> PE SC Received heck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By ash Remitted Service Request# <br /> 14 23 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />