COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

=vY�1lw\ 5 Lah �-�5-l-i I)Sr1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT c CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �T� J 'L /iiC. - CrrY/ZIP CROSS STREET /�. /ti��'�"��(� APN � ��—__PARCEL SIZE O� o OWNER NAME��J Ihfrl/tr�J6 �� PHONE �— OWNERADDRESS �]2 - CITY/STAT P CONTRACTOR vy PHONE CONTRACTOR ADDRESS _ _ CITV/STATE/ZIP --- - LICENSE CI C-42 U C-36 OTHER�. �_ NUMBERlf)Y34 EXPIRATION DATE - WATER TABLE DEPTH:_ _ft GEOGRAPHICAL INFORMATION: Coordinates X Y FL—PERC TEST N BUILDING PERMIT#_ _ LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALT NATIVE REPLACEMENT ___ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTIONS INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER l NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG _ CAPACITY_ _ __ gal N OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG __ CAPACITY _ gal N OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP _._ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS __— N OF LINES LENGTH OF LINES it DISTANCE TO NEAREST WELLit FOUNDATION it PROPERTY LINE it ft DEPTH ft ❑ FILTER BED WIDTH R LENGTH ft PROPERTY LINE ft DISTANCE TO NEAREST WELL ft FOUNDATION ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft FOUNDATION ft DISTANCE TO NEAREST WELLR PROPERTY LINE it [3 SUMPS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION h PROPERTY LINE Rft [3 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft FOUNDATION ft PROPERTY LINE ft DISTANCE TO NEAREST WELL it Ll SEEPAGE PITS NUMBER WIDTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I IIEREBY CERTIFY THAT I HAVE PREPARED THISL PLAWS AND RU SAND REGULATIONS OICATION AND THE WORK WILL 13E SAN N ALCORAQUIN ANCE ?ITH SAN JOAOUIN COUNTY ORDINANCES, INIMU OU ADV NOTICE REQIRE FOR INSPECTIONS-P EA E CALL 209 9 3-76 7 _. SIGNE L / TITLE. DATE H W Z O I TMENT t ��.{� Date �_ Area Employee IDN-la�ei�u-I-t✓ Application Accepted B _ _ [] SPEC AL PERMIT-Approved by Final Inspection By Date pit/Sump Soil Character: Character of Soil to Depth of 3 Ft: (( COMMENTS rigid,_ e ZPESC - Permit/ Invoice N Permit IDN Received Che kN/ Amount Date Service Re uest N B Cash Remitt1200 IXA- t• ONSITE WASTEWATER LTdi MNT SYSTEM PERMIT eo.m tjd