Laserfiche WebLink
F. <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 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 16779 E.Frazier Road CITY/ZIP L-LNaF N' q 5 2 3 e <br /> m <br /> CROSS STREET Tully Road APN 065-110-21 PARCEL SIZE 40 AC Y <br /> 0 <br /> c <br /> OWNER NAME Greg Mellor x <br /> PHONE <br /> OWNER ADDRESS 1560 N.DeWitt Avenue CITY/STATE/ZIP Clovis,CA 93619 <br /> CONTRACTOR Dillon&Murphy PHONE 209-334-6613 <br /> CONTRACTOR ADDRESS 647 N.CluffAve.,Suite A2 CITY/STATE/ZIP Lodi,CA 95240 <br /> LICENSE ❑FlC-42 ❑FIC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST #' BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: n NEW INSTALLATION fl REPAIR/ADDITION r1 ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-0F-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> O 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 fl <br /> O LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION (t PROPERTY LINE fl <br /> 0 FILTER BED WIDTH ft LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION K PROPERTY LINE ft <br /> 0 SUMPS WIDTH fl LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE _ R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE fl <br /> 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION it 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 /> MINIMUM 48 HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Staff DATE 11113/2019 <br /> �O <br /> R NTk 7r <br /> TMENT <br /> D'E ARTMENT SE N Y 4f'rl <br /> Application Accepted B Dae Area �/ Employee ID#_ <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil t epth of 3 Ft: Pit/Sump Soil Char�Cter: <br /> COMMEIs <br /> PE SC Received Ch k#/ Amount Date Permit) Invoice# Permit ID# <br /> Code INFO B as emitted Service Re uest# <br /> b <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4,14118 <br />