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 EXPIRES 1 YE <br /> FROM DATE ISSUED <br /> JOB ADDRESS 7 CITY/ZIP k Y v <br /> m <br /> CROSS STREET I APN I� y, 2� PARCEL SIZE Y V <br /> OWNER NAME /t�OY/� (/(/G r JT�6" %�r�v� _ _PHONE _�2p Z-13,5-70/ / m <br /> OWNER ADDRESSSiQ�Jlf(� //�� CITY/STATE/ZIP <br /> CONTRACTOR �/d/V 45p, PHONE <br /> CONTRACTOR ADDRESSCITY/STATE/ZIP <br /> LICENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEP71C 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 /> ❑ LIFT STATION SIZE TYPE OF PUMP_ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ 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 ftli t ITT <br /> M. — ft DEPTH ft <br /> DISTANCE TO`NEIIIAES� ! �� +. w e 9f p _ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ��.sY1{ ft dd LENGTH Grp �ifiii ,� ••��•/// ft DEPTH ft <br /> DISTANCE TO NEPRE§Mi IIL i yi� 41"1191 ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTHkr�'Effk <br /> `1.fiA16VI I In eted It DEPTH ft <br /> DISTANCE TO NE RE W(� L f Ir11 �?F U 4AT,ION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH �Yn�r!r'H� LpfG�l`�i `n'� " �IlI'Sf(��1 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 It <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 24 HOUR ADV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED _ _ TITLE_ U LG/,/L �'� DATE <br /> � U2� <br /> . <br /> D <br /> A AS <br /> 171 r! <br /> I <br /> L. <br /> �- DEPARTMENT USE ONLY <br /> Application Accepted Date� Area Employee ID#- bot, <br /> Final Inspection By Date ISP CIAL RMIT-A by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 2.11113 S UO <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />