Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT �pCA�LL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1Z $ 1n r-1 1"0 S A (--t> CITY/ZIP S-rz c4e--ru-r J 9Y-4o S- <br /> v' <br /> H <br /> C to <br /> CROSS STREET J lEGT I 0 a APN I -0�0 J.S . �-� PARCEL SIZE (3-�7` Ac- fj <br /> �j �,/� v <br /> OWNERNAME mt)F-IP4&� 1 P-A)�.�-XS c/0 V ITC -0 PN�O PHONE tic) <br /> t� <br /> OWNER ADDRESS CITY/STATEJZIP GS C-&L-VIQ 1 CA 4 r 3 XC) <br /> CONTRACTOR L IIJ L: O^le- &e O EN V 1 IUA"e"i-JT KL_ PHONE 3(O cf-O;1 7 •' <br /> CONTRACTOR ADDRESS '40-1 w• �� 5T' CITY/STATE/ZIP L•-O D L CA 1 2.40 <br /> LICENSE .C-42 'C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> '(, PERC TEST # 1I FBUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT _. DESTRUCTION <br /> INSTALLATION WILL SERVE: i RESIDENCE _! COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 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 It <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 w� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE A%, '�C�D <br /> 13 FILTER FILTER BED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION -ft PROPERTY LINE,tjly 1 <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH SA <br /> •/V IV 2020 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE v ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH Pkjl ILNJV CO <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE '�IYJ TY <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH cI�' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft MENp <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 /> INIMUM 24 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE 141aJ, IM fr/Z • DATE (, Z 0 <br /> i <br /> J <br /> DEPARTMENTPS ONLY Q <br /> Application Accepted y y Date // Da Area / Employee ID# <br /> Final Inspection By Date _1 SPECIAL PERMIT-Approved by <br /> Character of Soil to&pth of 3 Ft: P USump Soil Character: <br /> COMMENTS <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Remitted ervice Reqyest# <br /> LI3 ISS I <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />