Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMI"P <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)465-3420 <br /> NON-REFUNDABLE PERMIT j,CALL <br /> 209 953-7697 FOR INSPEC77ONS'�{- EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADORESS I y_--�' -US G f1 CITYIZIP-7� e,(A <br /> LA <br /> CROSS STREET P�l� APN.QSS n ....-PARCEL SIZE 5•s <br /> OWNER NAME T" Y U PHONrr�iT�ln �t� <br /> 3��� 1a5� 1 �Lmcn <br /> OWNER ADDRESS 3rA C1IYISTATElZ1P l�(^ r� <br /> CONTRACTOR PHONE 'P <br /> -h S'Ig <br /> CONTRACTOR ADDRESS <br /> CITYISTATE21P <br /> LICENSE i ..C-42 G ,C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y— <br /> E TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> 'TYPE OF WORK: NEW INSTALLATION REPAIRIADDITIDN ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: !.I RESIDENCE COMMERCIAL j� I I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 1 NU OF EMPLOYEES: <br /> Z/. SEPTIC TANK TYPFIMFG Is, CAPA¢f4Y_ �. all #OF COMPARTMENTS <br /> d GREASE TRAP TYPEIMFG CAPACC 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 LEACHING CHAMBERS #OF LINES LENGTH OF LINES- _ft <br /> 111 DISTANCE To NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ,�tlti ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED %MOTH R LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ftFOUNDATION It PROPERTY LINE It <br /> TASUMPS � q WIDTH 10 ft LENGTH 7 k It DEPTH �t1 ft <br /> I 0%'kv 14 " DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMsER 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 /> UM 24 OUR ADVANCE NOTICE REQUIRED FO NSPECTIONS-PLEASE CALL 20 95 7697 <br /> SIGN M/ TLE t/ II — — ATE S 10Z <br /> l <br /> D <br /> N <br /> U <br /> I <br /> DEPARTMEN SE ONLY <br /> Application Accepted B Date 7 Area S Employee ID#� <br /> - <br /> Final inspection By ' Date 1- SPECIAL P RMIT-Approved by <br /> Character of Soil to epP of 3 Ft: ✓T PiUSump Soil Character: <br /> COMMENTS <br /> .fi W1A r �,.L��` _—� _ .�•�___ Coca,.,; a girt <br /> PE SC Received he Amount Permly Invoice Permit ID# <br /> Code INFO B as Remi" Date Service Re uest# <br /> l t L1 3 t5 rL �2 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> I/Afll <br />