Laserfiche WebLink
F <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 L r � 411—i\ X00 CITY/ZIP <br /> r a <br /> CROSS STREET C,:�i r,C 5 14 64) APN PARCEL SIZE - <br /> c <br /> OWNER NAME �FG.tri � �- (��j-�fll�}' PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP 7 1 <br /> CONTRACTOR j IA n2 rrrl�4 — u' PHONE <br /> CONTRACTOR ADDRESS 0,n 1 e. LY5'n CITY/STATE/ZIP I! { ✓G7'Cz i ��� L <br /> LICENSE Il C-42 ❑i IC-36 OTHER 6 NUMBER {S7�4j`jGi 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 I REPAIR/ADDITION I_ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM _ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: l NUMBER OF BEDROOMS: —3 NUMBER OF EMPLOYEES: <br /> ®'`SEPTIC TANK TYPE/MFG MST L CAPACITY �- 7 t7 gal #OF COMPARTMENTS , <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ; �s i ft FOUNDATION (i�I ft PROPERTY LINE i7 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 PROPERT LINE ft <br /> Q FILTER BED WIDTH }n ft LENGTH j- ` ft DEPTH t�j �{ ft <br /> DISTANCE TO NEAREST WELL {<�C`l' ft FOUNDATION ('J{ ft PROPERTY LINE �l!S' 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 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 2 953-7697 <br /> SIGNED i IA 4, TITLEi�) �-'L-�i� DATE <br /> Zf 7 <br /> o <br /> lL <br /> J <br /> J IO lily ry <br /> I <br /> 0 <br /> 44 i xian <br /> DEPARTMENT USE ONLY / r ►�) ^ <br /> Application Accepted 13y Date Z C 11 Area (/T Employee ID#� <br /> Final Inspection By Date n /,T� 7-0 20 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: U Pit/Sump Soil Character- <br /> COMMENTS - <br /> J-4-C <br /> PE SC Received eck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By s Remitted Servic Request# <br /> $ �L <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />