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 PER IT CALL(209)953-7697 FOR INSPECTIONS EXPIRESs1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS )S� CITY/Z/IP]�_-7? ' <br /> CROSS STREET hCP�II �!XPi /�/f APN 7 /Z/ ` y PARCEL SIZE <br /> v <br /> v <br /> z <br /> OWNER NAME O4 ZA, PHONE <br /> y <br /> OWNER ADDRESS CAL., CITY/STATE//ZIP <br /> ' <br /> CONTRACTOR ' '/iiLLIi CA Al'U'O�o, a, F'��- PHONE <br /> CONTRACTOR ADDRESS _I U�LZO J�Lv� 2 CITY/STATE/ZIP <br /> LICENSE 1:11-IC-42 1111C-36 OTHER NUMBER 9SZ0 7g2S EXPIRATION DATE _ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: F; NEW INSTALLATION I REPAIR/ADDITION U ENGINEER DESIGNED/ALTERNATIVE <br /> 1-! REPLACEMENT U OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: �RESIDENCE El COMMERCIAL El OTHER <br /> N <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: '2- 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 O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES I I LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTEP.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 f/ ft <br /> DISTANCE TO NEAREST WELL 4O ft FOUNDATION /jJ 1-2- 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 it 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 /> MINIM&48 HOU DV CE NOTICE REQUIRED FOR INSPEC <br /> TIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Ci G I� DATE <br /> Y EN <br /> E VI 01IMENIAL <br /> HEA Tir DEPART14EPIT <br /> DEPARTMENT USE OINWLY <br /> Application Accepted By _ Date Area Employee ID# � <br /> Final Inspection By Date ❑ SP IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil^^Character: <br /> COMMENTS v Yv _ <br /> CA,s t. ��. .` - - - <br /> - — <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B CasIL Remitted ate Service Request# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14116 <br />