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 i j t' ' ' tA <br /> QG CITY/ZIP 5 tt el � l <br /> CROSS STREET ��� �Y,�i APN Q v PARCEL SIZE <br /> OWNER NAMES � /�LI / D /SII J ( PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR '� PHONE <br /> CONTRACTOR ADDRESS O CITY/STATE/ZIP 1f7L-1&;Py-1/ <br /> LICENSE ❑EIC-42 ❑I 'C-36 OTHER-04NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I_; NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> 1-1 REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 19 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 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 I LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 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_ �4 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL�3 "/' ft FOUNDATION ��f ft PROPERTY LINE .� �— ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 /> MINIM&48 HOUR VANC NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 9,53-7697 <br /> SIGNED TITLE ��L� DATE <br /> r <br /> 44k 7n n <br /> E Ln Q / <br /> T/y M N <br /> T <br /> DEPARTMENT US ONLY <br /> Application Accepted B ` Date Sa Area q1qC Employee ID# s ��✓�C?� <br /> Final Inspection By Date 11020 4SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: f Pit/sump Soil haracter: <br /> COMMENTS see SRoOgi >11 �r UPiIF�c�� I� , �,� Soca('. '– tD ► .5PGCC'. , SID Pei 1 <br /> 1�1e 1S /n5��,�r U• sVvr►b - (^Ield O!%V <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Servic Re est# <br /> yz10 ��s� 3�0 3 �y w �3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />