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 1/EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS O CITY/ZIP sS¢(qCJ K. CJD [n l 1 U <br /> nA I /� <br /> CROSS STREET'a 1(-A; lb\� ` 1C( APN f7 / PARCEL SIZE <br /> �/D <br /> OWNER NAME C nCy✓� r�Y�P e 1 J PHONE 1a '7`7 f C`IZ <br /> ^ p m <br /> OWNER ADDRESS r� G... {,A ACC) _ CITY/STATE/ZIP <� G�CSC,lel �_1`f <br /> CONTRACTOR �(�V6U� L S PHONE(20z) <br /> CONTRACTOR ADDRESS �)�I` ? �i I I i,I lI CITY/STATE/ZIP, C r-- o <br /> LICENSE 01'C-42 ❑LIC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I I NEW INSTALLATION REPAIR/ADDITION !I ENGINEER DESIGNED/ALTERNATIVE ` <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION 60g, 4gil <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ 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 J 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 LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH PAYMENT <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ®G/+ft=i\/f1=b <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 'A Z(1 2 V9 <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE SAN JOAQUIN COUN <br /> RIVIRGINMEWAL <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COHL(PRWMEN <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 488 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-7697 <br /> SIGNED TITLE O W kN_ e DATE - 12 - i <br /> 74 <br /> D PARTMENT JISE RNLY <br /> Application Accepted BV Date Area Employee ID# <br /> Final Inspection ByAAZ�a Date ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/SI mp Soil Character: <br /> COMMENTS �f����K -� /�o� <br /> PE Sc Received _G*Ock#/ Amount Permit/ <br /> ode INFO A AB YA mash Remitted ate Service Request# Invoice# Permit ID# <br /> o <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />