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 Jv CITY/ZIP aJCil` N rZ I J Z <br /> CROSS STREET / / PARCEL SIZE <br /> f L'�1 APN/.�� 7/ � � u <br /> OWNER NAME ✓, %� L, /`"Av.' � /PHONE <br /> OWNER ADDRESS 27 01 I J�1� �� N ,A© CITY/STATE/ZIP ' / 2 6 b � <br /> CONTRACTOR /*1441 (-e_ ��(�/��� L/ 'r �'J�/�^ PHONE y J 3 <br /> CONTRACTOR ADDRESS �' 7 �^iy[�- �� !J /` CITY/STATE/ZIP /A"' qfi�.r J <br /> LICENSE ❑CIC-42 1111C-36 OTHER /J NUMBER 7/S EXPIRATION DATE <br /> 1 <br /> WATER TABLE DEPTH: 0q V ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: U NEW INSTALLATION -O REPAIR/ADDITION 0 ENGINEER DESIGNEDLALTERNATIVE <br /> 1.7 REPLACEMENT CI OUT-OF-SERVICE SEPTIC SYSTEM U DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEE All <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMEE59 o_ 5 <br /> LI GREASETRAP TYPE/MFG CAPACITY gal #OF COMPAS �"��� <br /> � N <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPER44F AV7'ISR_o_lE�ITVTAI ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP C] PKG TX PLANT Ll SAND OIL SEPARATOR(ENCLO' EINT <br /> ❑ LEACH LINES tr- LEACHING CHAMBERS Q 3 #OF LINES LENGTH OF LINES ��d ft <br /> DISTANCE TO NEAREST WELL /(-)-) ft FOUNDATION 3 u 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 /> ❑ 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 ZJ ft <br /> DISTANCE TO NEAREST WELL^/50 ft FOUNDATION �� ft PROPERTY LINE S- 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 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLES%rJt� ��� DATE <br /> G <br /> � v <br /> J <br /> PAR TM ENT LIS ONLY <br /> Application Accepted B Date Area Employee ID det #���� �T <br /> Final Inspection By Date 7 ElSPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE Sc Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted Service Request# <br /> alN- <br /> Zs20u <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />