Laserfiche WebLink
Rw , <br /> OiNSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNIJABQLE PERMIT r ,( CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YE R FROM DATE ISSUED <br /> JOB ADDRESS 1 �"T�/ wyb �2��� CITY/ZIP <br /> CROSS STREET kE rA O V�(�'�CM�-) <br /> � L r-J APN 0 A �' �� "� J PARCEL SIZE • <br /> OWNER NAME `-�. � t-j PHONE ` <br /> OWNER ADDRESS ` `�c�O �yCITY/STATE/ <br /> Z <br /> IP <br /> LOC LCi r-J1 L.,IL- <br /> CONTRACTOR �J S� ��5� PHONE <br /> CONTRACTOR ADDRESS -- ..1_ CITY/STATE/ZIP <br /> LICENSE C-42 C-36 OTHER Cf- ` t ` NUMBER S t{S] _EXPIRATION DATE I 1 LL <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION w REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> s*'. REPLACEMENT "(�.de� OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE I I COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: nn NUMBER OF BEDROOMS: C NUMBER OF EMPLOYEES: <br /> - SEPTIC TANK TYPE/MFG 0CAPACITY gal #OFCOMPARTMENTS Z— <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE it <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 LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINI UM 48 H008 AD OT10E.REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE ✓ `� �� <br /> I <br /> 9 <br /> NTY <br /> VIE La ME T NL <br /> H ITHDEPARTMENT <br /> DEPARTMENT SE O LY c� <br /> Application Accepted By Date Area -l—� Employee ID# D <br /> Final Inspection By Date I I SPE�CIAL PERMIT-Approved by <br /> Character of Soil to De th of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> � kQ <br /> PE SC Received Beek#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Re uest# <br /> �SoDSt� CSt' <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />