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 PERMIT CALL(209)953-7697 FOR INSPECTIONS (� M EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �'J 2- 1' 1 I Ll)r V / CITY/ZIIP�J/[�� <br /> CROSS STREET I' - h �_ 5` APN -2 1%/ 20"y; PARCEL SIZE <br /> t7 <br /> I��Ph r y nrIPV� S� <br /> OWNER NAME � PHONE <br /> f <br /> OWNER ADDRESS 2 M/ I��D ! UP CITY/STATE/ZIP /f�1 y C4 I �-J k b <br /> CONTRACTOR U S5 C o7hS rt��,�un PHONE <br /> CONTRACTOR ADDRESS ✓ �V,I( L9 CITY/STATE/ZIP R1 pot,, <br /> LICENSE ❑0C-42 ❑GIC-36 OTHER 'J NUMBERIg7�75 EXPIRATION DATE '5' " /D-,O,? <br /> WATER <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: LI NEW INSTALLATION ❑ REPAIR/ADDITION U ENGINEER DESIGNED/ALTERNATIVE?' <br /> Cl REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM >0 DESTRUCTION :T06!S� <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Li LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Lel LEACH LINES ❑ LEACHING CHAMBERS #OF-LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ 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 /> Q DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ 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 /> MINIAaUM48 HOUR 4DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Co/1�IoV' DATE <br /> rt <br /> SAL I <br /> J COD <br /> 1 <br /> r <br /> r <br /> DEPARTMENTUSEONLY <br /> Application Accepted By A on Date Area Employee ID# <br /> Final Inspection By Date I � I] SP01AL RMIT-Approved by <br /> If <br /> Character of Soil to I 3 F Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit! <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> f .5RO 8 13 / <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />