Laserfiche WebLink
t <br /> 4 <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 !/ '(2(- �fv e CITY/ZIP Z <br /> Y u <br /> CROSS STREET / C,.,, L' L L.,tU (�, APN (9 Q::2 S 0 �_PARCEL SIZE <br /> OWNER NAME / G d (,/i( Div PHONE <br /> �l p L/l/, , 9 4 <br /> OWNER ADDRESS ���? � ]D S ��7 � fQ\�� CITY/STATE/,ZIP �/�e.y� GYM r),, 25/3 ,� t <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑f�C-42 0IJC-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: I NEW INSTALLATION REPAIR/ADDITION ENGINEER DESI*ED/A RNA <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION yj <br /> INSTALLATION WILL SERVE: 1- RESIDENCE ❑ COMMERCIAL j 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 /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG T)%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 /> O FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE eA <br /> ❑ IIJOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE SAN IB V 'Cu fQ <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH . E U/ Y <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ ft <br /> ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH <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 /> MINI UM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL L2091953-7697 <br /> SIGNED 4. 0 TITLE (f <br /> P DATE <br /> t <br /> PARTMENT SE NLY <br /> Application Accepted By Date Area Employee ID#- -;�Mwa <br /> _ <br /> Final Inspection By _ Date ❑ SPE AL PERMIT-Approved by <br /> Character of Soil to Dept of 3 Ft: ____ __ _ Pit/Sump haracter: <br /> COMMENTS�D,J�f�/�- - - - -- ---- <br /> PE Sc Received Check#/ Amount Permit/ <br /> Code INFO By lRernitted Date Service Re uest# Invoice# Permit ID# <br /> Z 5-I1P1�1_ � 0(p <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />