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 PE 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �V 0 CITY/ZIP <br /> CROSS STREET ^ APN C; PARCEL SIZE <br /> OWNERNAME / QI PHONE Snnp�L^ <br /> OWNER ADDRESS VY� L-A%WCAj k.4 CITY/STATE/ZIPAQ_ n_-A <br /> N <br /> CONTRACTOR S. PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑CIC-42 ❑FIC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#1`4j" LAND USE APPLICATION# <br /> pq <br /> TYPE OF WORK: It NEW INSTALLATION IN R AIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT 17 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION L <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG _ Lf CAPACITY O V gal #OF COMPARTMENTS <br /> GREASE TRAP TYPE/MFG CAPACITY gal #OF COKPARTMENTS <br /> 1 <br /> DISTANCE TO NEAREST: WELL 2ao 1 ft FOUNDATION I ft PROPERTY LINE t.Cd r ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> /f <br /> LEACH I LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES /��l� ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION l I ft PROPERTY LINE ft <br /> G 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 /> G 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 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 /> NIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNE 2G1J TIT <br /> ©ovYl-QJ�� DATEj\'j ^13 <br /> E / <br /> rM oVM1N <br /> FN <br /> EPARTMEN,& OSEbNLY ��( //►► <br /> Application Accepted By Date Area Employee ID#�S�(✓-�b,�„°A <br /> Final Inspection By Date_ 2 ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: f!�(aj 7rd L Pit/Sump Soil Character: <br /> COMMENTS 1151L .J T —u� I� <br /> Fef <br /> PE Sc Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B s Remitte Service Request# <br /> 0 °I �3'1°t ►2 opsi i SS <br /> OU 30- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />