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 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Y/O €imer jo i CYC/ CITY/ZIP /yC11H9190. a <br /> CROSS STREETi4x" � yJrq Sy-e APN©©S—1 50 -/ PARCEL SIZE b <br /> /� <br /> llCC �- d <br /> OWNER NAME _ �O� JV PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR �7 <br /> cSTG1//� C �� PHONE_ ��- �4! J�c,p17 <br /> CONTRACTOR ADDRESS 3 / 11� TGZ�I� /-(Kle CITY/STATE/ZIP � � �`j'y 64" <br /> LICENSE ❑X-42 Ell-IC-36 OTHER NUMBER EXPIRATION DATE <br /> i <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL /J ❑ OTHER <br /> NITS: <br /> NUMBER OF LIVING Ut NUMBER OF BEDROOMS: (/ NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 'Y 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 F-1. LEACHING CHAMBERS #OF LINES LENGTH OF LINES //Dr ft <br /> DISTANCE TO NEAREST WELL Sa ft FOUNDATION 7� ft PROPERTY LINE /a r 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 /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> (/ / <br /> ] SEEPAGE PITS NUMBER WIDTH .3 ft DEPTH C;�S ft <br /> / DISTANCE TO NEAREST WELL /00 ft FOUNDATION GAO ft PROPERTY LINE l� ` 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 /> MINIMUM48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> SIGNED '//i/ TITLE LIJ�//� �il�� DATE <br /> EV/ ON <br /> �UrH_ E <br /> EPARTMENT USIE ONLY <br /> Application Accepted By Date Area Employee ID#� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved 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 B Remitted Service Re uest# <br /> O 2_H120 '1Q^-�1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />