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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> � i-5 e5 <br /> ,JOB ADDRESS O CIrY21P /�/+ e 11 <br /> JA <br /> CROSS STREET STREET -�/ , mo. i AD�PSN ' PARCEL SIZE�I <br /> OWNER NAME qZ5-�/ <br /> PHONE <br /> ��r J ME <br /> OWNER <br /> OWNER ADDRESS / ©DCITY/STATE IZIP <br /> CONTRACTORlL��i,lr�Gl PHONE f -Lz <br /> CONTRACTOR ADDRESS /n,Z2_'�! 441�' ��y�5� CCITY/STATE/ZIPS7 i1/t� l.��y S /�` <br /> LICENSE�1C-42 I�C-36 OTHER NUMBER '_:YE%PIRATION DATE <br /> � <br /> WATER TABLE DEPTH: n1 ice/ - IS' <br /> it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDMON ENGINEER DE IGNED/A TERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM J( DESTRUCTION TA n K <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE X COMMERCIAL I OTHER <br /> NUMBER OF LIVING UNITS: nn NUMBER OF BEDROOMS:____ NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG;2 CAPACITYZ600 2 gal If OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG �,/�Q CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 15�/ Il'II�,FOUNDATION it PROPERTY LINE—it <br /> LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Afa W ---- _- — -- <br /> O LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF UNES ft <br /> DISTANCE TO NEAREST WELL ItOUNDATION it PROPERTYLI E it <br /> FILTER BED WIDTH ��_ft LENGTH 3ft DEPTH 5� it <br /> v DISTANCE TO NEAREST WELL '�:�UNDATION f1 PROPERTY LINE it <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH it <br /> DISTANCE To NEAREST WELL It FOUNDATION It PROPERTY LINE 1+� it <br /> 13 SUMPS WIDTH it LENGTH it DEPTH PAVAa,-.-_.N <br /> DISTANCE To NEAREST WELL It FOUNDATION it PROPERTY LINE �R <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH it DEPTH LM <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE nrT Il it <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH_ y, <br /> I I all it <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PRO—PER-TTYY LINE JOAGUI f1 <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUING "pSP <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVA E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209).953-76.97 <br /> SIGNED TITLE� DATE�Z�- <br /> PARTMENT SE O&LY A� <br /> Application Accepted 1 Date Area Employee ID#� <br /> Final Inspection By Date_ I ❑ SPE AL PERMIT-Approved by <br /> Character of Soil to Depth f Ft: A Pit/Sump Soil Character: <br /> COMMENTS I� �' 1;.:; . ! ;< :�� G 1 x ' fo 4 zcn,it 4A <br /> i <br /> 1/3C7/,-: r' a trV <br /> PE SC Received hec Amount D to Per Invoice# Permit ID# <br /> Code INFO ash Remitted rvice Reue./sIt# <br /> Y <br /> i <br /> 42-01 L Il I e o ` Cis C NSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />