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 1 CALL 209 953-7697 FOR INSPECTIONS �EXPIRES <br /> /1 YEAR FROM DATE TISSUED <br /> JOB ADDRESS 7- // J ,R Lvu.-'J ez�� CITY/ZIP 'd ��"��= 4LK�cL •S�7 G' �' <br /> CROSSSTREET '✓ APN l/ ✓�O! y PARCEL SIZE J _2_Ay <br /> o <br /> OWNER NAME 'Ji=r�J/yL] -I'C I-- <br /> - PHONE �{ w <br /> OWNER ADDRESS !t(C_I_ U 1rr wtl�-- CITY/STATE/ZIP lJ <br /> CONTRACTOR c:-%- 1, h/C< - PHONE C, <br /> CONTRACTOR ADDRESS �/7L� !�-'✓•� '�a^' �hn�C' J'�i'L CITY/STATE/ZIP ` •^' `\ <br /> LICENSE 0,ht.42 11 C-36 OTHER NUMBER / � EXPIRATION DATE AV Z/ <br /> WATER TABLE DEPTH: /V `' ft GEOGRAPHICAL INFORMATION: COOrdina s X Y <br /> C PERC TEST # BUILDING PERMIT# - AND USE APPLICATION# t <br /> TYPE OF WORK: NEW INSTALLATION R AIR/A DITION ENGINEER DESIGNED/ALTERNATIVE �- <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: V_(�RESIDENCE I_ COMMERCIAL LI OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: ) NUMBER OF EMPLOYEES: <br /> ,a SEPTIC TANK TYPE/MFG �1 C. CAPACITY /ZC4Lf gal #OF COMPARTMENTS v <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 /> :S LEACH LINES LEACHING CHAMBERS #OF LINES 3 LENGTH OF LINES ft <br /> DISTANCE <br /> ft <br /> DISTANCE TO NEAREST WELL1SC/- ft FOUNDATION SD ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH it DEPTH h <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE h A <br /> ❑ MOUNDED WIDTH ft LENGTH it DEPTH h I� �ir <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Cj ��� <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE a Af ft <br /> LI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft 7 (J �� �j <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE A� qQV i/ <br /> :.5_ SEEPAGE PITS NUMBER ? WIDTH y .I ft DEPTH • S NSI RV `AKN II V C0UN <br /> To NEAREST WELL ft <br /> ft <br /> ERTY LINE <br /> ry <br /> FOUNDAT <br /> ON <br /> I HEREBY CERTIFY THAT I HDAVE PREPARED THIS APPLICATION AND THE WORK WILL BE(DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, �EpAR MEIy 7- <br /> STATE LAWS AND RULES AND REGULATIONS OFF SAN JOAQUIN COUNTY. <br /> 4 DYANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-769 <br /> SIGNED -- ' TITLE DATE <br /> 1 <br /> 1.771 <br /> c <br /> 5 <br /> D ARTMENT E NLY <br /> Application Accepted By Date Area Employee ID#_�I _ <br /> Final Inspection By Date � L; $PE IAL PERMIT-Approved by <br /> Character of Soil to Pepthhoof 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS ��/(��f�((/��- 1��IF� <br /> PE SC Received Chgck#V Amount Permit/ <br /> Code I INFOB C s emitted Date Service Re uest# Invoice# Permit ID# <br /> r 7 Z(,`1 5 JZ 0, 11,Uk, <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />