Laserfiche WebLink
� D-_t, 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 YE/ <br /> ! A�R FROM DATE ISSUED <br /> JOB ADDRESS 1 1 W CITY/ZIP <br /> � ( I LC "/ -v <br /> CROSS STREET l CI VYI Yh a I"S f! APN--21 PARCEL SIZED�a�' c <br /> OWNER NAME I)Gc`f' L �- PHONE <br /> OWNER ADDRESS Celnfft- CRY/STATE/ZIP �'�W Offr V � <br /> qq6 <br /> CONTRACTOR C. V �� r^ _ PHONE _ „^-/� aql �j� <br /> CONTRACTOR ADDRESS 1 I? 4 C-O C V� Ar�_ yy CITY/STATE/ZIP �7/77f V�e� /_5?6 fo <br /> LICENSE QC-42 7C-38 OTHER C_2—'i NUMBER 1( /� 1 EXPIRATION DATE-----7--31- <br /> ATE___ ( --31- 9-D <br /> (Z,s( <br /> WATER TABLE DEPTH: H GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L NEW INSTALLATION F REPAINADDITION C ENGINEER DESIGNED(ALTERNATIVE <br /> REPLACEMENT f I OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: L RESIDENCE U COMMERCIAL ❑ OTHER <br /> NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:__ <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG 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 L LEACHING CHAMBERS #OF LINFS LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WFI L ft FOUNUArICN_ it PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft D=_PTH It <br /> DISTANCE TO NEAREST WELL _ It FOUNDATION 0 PROPERTY LINE it <br /> ❑ MOUNDED WIDTH tt LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH _ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION . . ft PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH _ .ft LENGTH tt DEPTH It <br /> DISTANCE TO NEAREST WELL- ft FOUNDATION ft PROPERTY LINE N <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PHOPE RTY LINE It <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 /> MINIM 24 HOUR AOaNCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE 1 N��aII�Lc�t 1' DATE <br /> ED <br /> Ulf <br /> Zan <br /> C� N <br /> ` — - - <br /> DEPA USE NLY <br /> Application Accepted By ��^� Date °r % !__3_. Area 9`r Employee ID# <br /> Final Inspection By Dete ❑ SPECIAL PERMIT-Approved by _ <br /> Character of Soil to of 3 Ft: PIUSum Iter: <br /> COMMENTS <br /> PE SC Received heck#/ Amount PermiU <br /> Date Involco# PermillD# <br /> Code INFO B Remitted Service Reauest# <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PLHMIT <br /> 4!24112 <br />