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 n( CALL 209)953-7697 FOR INSPECTIONS _ EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 (0 3a-71 <br /> CITY/ZIP r�1 <br /> CROSS STREET APN O- PARCEL SIZE •U a <br /> OWNER NAME //" �� PPH/ONNE <br /> OWNER ADDRESS ' ��/ ( / � tet) CITY/STATE//ZIIP/'� i vy! , <br /> CONTRACTOR $'Y 11 PSIS /1I'1PHONE <br /> CONTRACTOR ADDRESS i - 6�i0 �Si� CITY/STATE/ZIP <br /> LICENSE ❑CIC-42 ❑ C-36 OTHER NUMBER �G��S7J EXPIRATION DATE <br /> 1 <br /> WATER TABLE DEPTH:Ob` ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # i BUILDING PERMIT# - LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION L_I R PAIR/ADDITION Cl ENGINEER DESIGNED/ALTERNATIVE <br /> L.1 REPLACEMENT CI OUT-OF-SERVICE SEPTIC SYSTEM IJ DESTRUCTION <br /> INSTALLATION WILL SERVE: WIRESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: -3 NUMBER OF EMPLOYEES: <br /> Oo"'SEPTIC TANK TYPE/MFG fit} L CAPACITY �t�7� gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION h ft PROPERTY LINE�;, ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> tV LEACH LINES I_' LEACHING CHAMBERS #OF LINES LENGTH OF LINES 160 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 15� ft PROPERTY LINE � ( ft <br /> ❑ FILTER BED WIDTH ft LENG H 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 HOUR41YVANCE NOTICE RE DIRE®FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br /> SIGNED TITLE n 'J GC-'l;j DATE��� j � <br /> '9 <br /> ti ti <br /> ti <br /> 'lf <br /> PAR TM ENT IS F,0 N L Y <br /> Application AcceptADep <br /> Date Area Employee ID# <br /> Final Inspection By Date El SPEC AL PERMIT-Approved by <br /> Character of Soil toftof3Ft: !e t/Sump Soil Character: <br /> COMMENTS _ -ff _ 0 I/_—V�' //(/�� �CIAr%—lA I/ <br /> PE Sc Receivedheck# Amount Permit/ <br /> Code INFO B ash Remitted Date ervice Re ues # Invoice# Permit iD# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />