Laserfiche WebLink
e <br /> i <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 EXPIRES 1 YEA FROM DATE ISSUED <br /> JOB ADDRESS ��7S •�� CITY/ZIP LOC 70 ct `tea <br /> CROSS STREET GOA/ AP �� —PARCEL SIZE Y <br /> o <br /> !J7 <br /> OWNER NAME �[ /S//�/G� PHONE <br /> OWNER ADDRESS ✓ AA1 ✓ ��"�cT CITY/STATE/ZIP �(OG fGIQ✓ /�ZD�� <br /> CONTRACTOR f �"� (/� I�'�Q//✓F�� ? PHONE /p-'Ojf <br /> CONTRACTOR ADDRESS 0 ��X J 2� CITY/STATE/ZIP <br /> LICENSE ❑1IC-42 0I'C-36 OTHER N U M B E �4?1 //j EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: P NEW INSTALLATION J REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> C REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION � <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL J OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 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 /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEit <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH IN C �ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH "Lltft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY 1_II ✓O ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH N�� I Y ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ ft <br /> ElSEEPAGE PITS NUMBER WIDTH ft DEPTH T 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 /> M INIAWI <br /> M 48 HjZR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE fET .e6�'o� DATE ' 2 �� <br /> IF <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date 11 SP IAL ERMIT-Approved by <br /> Character of Soil to ptl f 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS �.t.�• <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> Z �- <br /> 42-01 l}�/�`-�C/ L� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />