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)953-769v7 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRES: rre"47 1�--5 ��t��{ tom/ CITY/ZIP �s f �0�- J -I� <br /> � w r7 <br /> CROSS STREET GLt/-C 44 APN 1 G l ) PARCEL SIZE ! p <br /> d <br /> OWNER NAME I~5l6 Cfe5 1co In C' �� PHONE O ��''�22U �o <br /> OWNER ADDRESS 1, St, W L��1�1F' A0 � $ 3?S CITY/STATE/ZIP <br /> CONTRACTOR Y r 1,14-A! tank <br /> '(�I i} L� 0 . PHONE <br /> CONTRACTOR ADDRESS 112 ta -i►'-�p •� /� CITY/STATE/ZIP <br /> LICENSE ❑I1C-42 ❑ 'C-36 OTHER NUMBER&J �JJ"� EXPIRATIONDATES <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#_,_, LAND USE APPLICATION# <br /> TYPE OF WORK: [-I NEW INSTALLATION Pr' REPAIR/ADDITION Ll ENGINEER DESIGNED/ALTERNATIVE <br /> I REPLACEMENT LI OUT-OF-SERVICE SEPTIC SYSTEM LJ DESTRUCTION <br /> INSTALLATION WILL SERVE: &,4rESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: I 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 /> U,-'LEACH LINES 1 1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ' / ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �S� 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 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 ft DEPTH 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 48 VANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209)X9953-7697 <br /> SIGNED TITLE <:<%in (-Ce4j r DATE <br /> C VED <br /> 6 <br /> T D P T E T <br /> ` DEPARTMENT USENLY <br /> Application Acceptel By Date V z 61 Area Employee ID# <br /> Final Inspection By Q Date oElSPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Characte <br /> COMM NTS /5 <br /> twb , <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO By Cash Remitted Date Service Request# Invoice# Permit ID# <br /> � � ov l 3Q06�1 (3D <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />