Laserfiche WebLink
r .-'N <br /> ONSITE WASTEWATER T EATMEN I, SY 'FEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFU14DABLE PERMITCALL(209)953-7697 FOR INSPECTIONS EXPIRES '8 HEAP.FROM CRATE ISSUED <br /> JOB ADDRESS T,� _ (4w',l U-0 CITY/ZIP <br /> CROSS STREET .— ''� _ APN�� '2,60 ! Q PARCEL SIZE <br /> OWNER NAME c: It ,P {�✓1.'4 -"1-�- `� PHONE --- ---- - '. <br /> OWNER ADDRESS �� Y3r`��NN 7 � CITY/STATE/ZIP _ �5 1-it., <br /> CONTRACTOR­....On <br /> �Jf� I r <br /> V ��-�4` `:CIC(�t t-1 � PHONE"( '� <br /> CONTRACTOR ADDRESS _ _ y� �Cj V CITY/STATE/ZIP J�r <br /> LICENSE 0 IC-42 (JI IC-36 OTHER o� NUMBER EXPIRATION DATE_ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X y Y <br /> ❑ PERC TEST # BUILDING PERMIT# -AND USE/APPLICATION <br /> TYPE OF WORK: tj NEW INSTALLATION 1_' REPAIR/ADDITION I I EEEER DESIGNED/ALTERNATIVE <br /> IJ REPLACEMENT 11 OUT-OF-SERVICE SEPTIC SYSTEM (601 DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE ❑ COMMERCIAL - ❑ OTHER <br /> N BER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> GREASE TRAP TYPE/MFG CAPACITY 9,11 #01°COMPARTMENTS _ <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> LIFT STATION SIZE TYPE OF PUMP M PK'G TX PLANT L3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> G] LEACH LINES Ci 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 /> I 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 /> l� SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT --------- -- _ _ <br /> 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 HOUR ADVANCE NOTICE REG)UIRED FOR IN/SPECTIQNS� - PLEASE CALL (229)�L3L7/ !Ll <br /> SIGNED TITLE � t4 yi,,(— /`4�T DATE <br /> _ DA M)wM Ile U <br /> HE WH �E <br /> PARTIVIENTIJSE jtNLY <br /> Application Accepted By Date Area Employee ID <br /> Final Inspection By Date ❑ SPE AL PERMIT-Approved by <br /> Character of Soil to Depth of Ft: Pi Sump ii Chara er: _ <br /> COMMENTS <br /> PE SC Received Check#/ AMOUnt Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit!D# <br /> 3-41 959 ONO2 <br /> `42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 41"14118 <br />