Laserfiche WebLink
f <br /> 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 PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 7151 E.Peltier Road CITY/ZIP Acampo 95220 w <br /> m <br /> CROSS STREET Kennefick Road APN 005-260-61 PARCEL SIZE 4.4 0 <br /> 0 <br /> OWNER NAME Holdener,Timothy R.&Lani PHONE (209)603-1000 <br /> OWNER ADDRESS 7151 E.Peltier Road CITY/STATE/ZIP Acampo,CA 95220 <br /> CONTRACTOR Dillon&Murphy PHONE (209)334-6613 <br /> CONTRACTOR ADDRESS 847 N.Cluff Ave. CITY/STATE/ZIP Lodi,CA 95241 <br /> LICENSE Ll--C-42 J--C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> G PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# 1800304 <br /> TYPE OF WORK: Li NEW INSTALLATION ❑ REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: L RESIDENCE L COMMERCIAL L OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 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 /> ❑ LIFTSTATION SIZE TYPE OF PUMP 0 PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTERBED WIDTH ft LENGTH ft DEPTH ft q <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH T <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE_ wV ft �O�^ <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH 40 ^ y <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE HA ♦ 4 w�"'V CO <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ��'_/ NMcNTUN�Y <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Fp'9RTMENT <br /> 1 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 /> MINIMUM 48 IJQVB ADVANCE IN TICE REQUIRED F C N -PLEASE CALL <br /> SIGNED TITLE SIA DATE I0/2 2 / <br /> * <br /> SIE El A T T A C H M E N T <br /> DEPARTME T LkSE ONLY <br /> Application Accepted B A j I Date V ZZA a Employee ID# I�7N . <br /> Final Inspection By Date L SP IAL PERMIT-Approved by <br /> Character of Soil t Depth of Ft: Pit/Sump S it Characte. <br /> COMMENTS �/1 <br /> PE SC Received Ch Amount D Permitt Invoice# Permit ID# <br /> Code INFO By. ash Remitted Service Re uest# <br /> 0 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />