Laserfiche WebLink
1 �+ <br /> f , <br /> 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 h U EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Ce& 1 Ci `J AID CITY/ZIP L-r A r� GVl <br /> r a <br /> CROSS STREET 13. S C, Re,((6�-�u A�P1N ��'� 3 ��y�Lj__ _ , PARCEL SIZE j <br /> OWNER NAME_ L V�r (-� ArayT K,,�S l P PHONE 1177 <br /> OWNER ADDRESS / 0 eOX y� J CITY/STATE/ZIP �1�oK�P///C.4 <br /> CONTRACTOR_fty ? 5 Y7�4C(SG.�'C� P r(CJI"c:C_ PHONE <br /> CONTRACTOR ADDRESS -A �Cb` Cp S� CITY/STATE/ZIP }�1c✓�e�-A,���'1t `J7�ti G, <br /> LICENSE [)I;C-42 LI!'C-36 OTHER +11 NUMBER. �p�p�� EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> L7 PERC TEST # BUILDING PERMIT#_ LAND USE APPLICATION# <br /> TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> I REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: &-_ ESIDENCE 1 1 COMMERCIAL 11 OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: —2 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG 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 /> EY LEACH LINES LEACHING CHAMBERS #OF LINES_� LENGTH OF LINES LI(�} ft <br /> DISTANCE TO NEAREST WELL1601 f ft FOUNDATION ft PROPERTYLINE 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 WEI_I_ 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 3Co r� ft DEPTH 25: ft <br /> DISTANCE TO NEAREST WELL 1 r,,-61_ ft FOUNDATION 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 HO ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE (� <br /> T <br /> A <br /> VC <br /> j4 A <br /> - <br /> RT <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID#_�� <br /> Final Inspection By — Date n SP IAL PERMIT-Approved by <br /> Character of Soil to De of 3 Ft: Pit/S` ''p Soil Character: <br /> COMMENTS <br /> PE SC Received Chec Arnount Permit/Date Invoice# Permit ID# <br /> Code INFO B Remitted-- Service ReqUest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />