Laserfiche WebLink
ONSITE WASTEWATE TR AT,aENT SYSTEM PERMIT s <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTO dA 9520'6-(209)468,-4N <br /> NON-REFUNDABLEPERMIT ALL 209 953-7 9 7FORINSPECTIONS f EXPIRES 1 Y , •f,ROMDATE,ISSUED]� <br /> JOB ADDRESS ( � L/ G / nn f`F� CITY/ZIP �+ L1 <br /> CROSS STREET J f ' ( r + fJ APN 1 -7 PARCEL SIZE <br /> OWNER NAME {�y,w4 `DRob.r+73+ i t�►')'�, �, G PHONE G'y�-t'�I <br /> OWNER ADDRESS 1 fl `I-C 7J 4�~Yw r C, CITY/STATE/ZIP SfaCAA ^ `` `' <br /> CONTRACTOR 1 c ` PHONE Lr 5'_ ?bL ` <br /> CONTRACTOR ADDRESS X `' CITY/STATE/ZIP i�' 1`A�-<« <br /> LICENSE ❑0C-42 ❑0C-36 OTHER #4 - NUMBER Ofl J5YEXPIRATIONDATE ;90 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INF RMATIO : COordl es X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 0 REPAIR/ADDITION Cl ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT U OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: L FIESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: R NUMBER OF BEDROOMS: S NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG F 4 i_ CAPACITY ' gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> I I <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION I ft PROPERTY LINE ' ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> &Z LEACH LINES ❑ LEACHING CHAMBERS #of LINES 3 LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL 50ft FOUNDATION 101 <br /> ft PROPERTY LINE (a ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ElMOUNDED WIDTH ft LENGTH ft DEPTH Q�w_ IVT ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE % Wlfbft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTHft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERI"5 ft <br /> JJ 1 10 qQU <br /> El DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT NMF N <br /> I. n. ft <br /> L3 SEEPAGE PITS NUMBER WIDTH ft DEPTH R?iPAr 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 24 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE L� 4c+� DATE �G <br /> U` <br /> C <br /> PARTAfE T <br /> Application Accepted E I <br /> hl��DDate Area 1�r�l! Employee ID# <br /> Final Inspection B Date ❑ SPECIAL PERMIT-Approved by <br /> P Y <br /> Character of Soil to Depth of/3 Fte Pit/Sump Soil Character: <br /> COMMENTS LLL) C"(4 <br /> PE SC Received -Check Amount Permit/ <br /> C deY -INFO B Cash Remitted Date Q SerMviccee R7equest# Iy/nvoi1ce# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />