Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
ONS f E WASTEWATER T REATMI EN u SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 9868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL <br /> t 209 953-7697 FOP.INSPECTIONS EX.PIRESI YEAR FROM DATE ISSUED <br /> JOB ADDRESS 11600 �, rT %1••,- Ave CITY/ZIP SOC l7 N` 1/^, A <br /> I ^� � ti <br /> CROSS STREET&_�11���!61r�i^ APN& _7_ V 05 QPARCELSIZE r /- <br /> OWNER NAME � r yy\eS A i Llk) f p P�HHOJNE /�(�-�D��l��j19/ vh <br /> OWNER ADDRESS , CITY/STATE/ZIP S eex4enr� CA, <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITYISTATE/ZIP <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # 66ILDING PERMIT# --I T OV LAND USE APPLICATION# <br /> TYPE OF WORD: %C NEW INSTALLATION ❑ REPAIR/ADDITION Ll ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: JR. RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: /- NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG L CAPACITY �loDl� gal #OF COMPARTMENTS_ <br /> I J GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL /Do ft FOUNDATION �O ft PROPERTY LINE <br /> A: �_.f„ ft <br /> P4 LIFT STAT ION SIZE TYPE OF PUMP G9 PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES <br /> LENGTH OF LINES go ( ft <br /> DISTANCE TO NEAREST WELL /100 / ft FOUNDATIO}9( :7 ft PROPERTY LINE c -toe- ft <br /> hI FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> El MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft -- PROPERTY LINE ft <br /> Q DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER _31 WIDTH �[a r/ ft DEPTH �( � / / ft <br /> DISTANCE TO NEAREST VJLI-I- S1� ft FOUNDATION ADD / ft PROPERTY LINE / Z9 7.'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 /> M§ UII/I YO MOOR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 C7 <br /> SIGNED TITLE 19IRS Ill'ee(P_ DATE-6--6— 2 O / <br /> k7 nL <br /> lu 20 <br /> Nly <br /> T <br /> AL <br /> HDEAT ET <br /> 1? fRTMENT-a.EN Y <br /> Application Accepted ate Area Employee ID#1� <br /> Final Inspection By . Date j8✓ PE IAL PERMIT-Approved by <br /> Character of Soil to ept"aAW"W" L �1 Pit/Sump Soil haracter: (r <br /> COM MENTS �1Z <br /> T ) <br /> E Sc Receiv C ll Amount Dat Permit/ Invoice# Permit ID# <br /> ode INFO Q ash Romitted Service Request it <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />