Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> KION-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS g 5"a CITYIZIP jr 'Gel dill v' <br /> H <br /> n <br /> CROSS STREET APN dy� t9 3zsa�{ PARCEL SIZE p <br /> j b <br /> OWNER NAME � I GfA � 00rAA!j Q- Ca f� PHONE <br /> N <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR ,�GGfS 94s 59(ae _ ` PHONE_k �G 4�Lr5_ <br /> CONTRACTOR ADDRESS en IAO)C (?�� CITY/STATE/ZIP <br /> LICENSE ❑LIC-42 ❑IJC-36 OTHER NUMBER&& EXPIRATION DATE <br /> WATER TABLE DEPTH: b a~,1 o ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: C NEW INSTALLATION #tl REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> L1 REPLACEMENT 171 OUT-OF-SERVICE SEPTIC SYSTEM D DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 131 SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> U GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> D LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES 461 ft <br /> DISTANCE TO NEAREST WELL (nnI_ ft FOUNDATION SI ft PROPERTY LINE (p( ft <br /> FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 13, MOUNDED WIDTH ft LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ ft <br /> SUMPS WIDTH der ft LENGTH ft DEPTH t!Q ft <br /> DISTANCE TO NEAREST WELL ��a` ft FOUNDATION -2 St ft PROPERTY LINE (61 ft <br /> LJ7 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 119W3 ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209) 953-7697 <br /> SIGNED TITLE �/��cce-1 DATE,(,!> �,0?e <br /> 4fT -6 1 <br /> 1791 <br /> r <br /> Ovl�t'lie R <br /> p / DEPARTMENT •US ONLY �1 <br /> Application Accepted B e-- Ll—y Date 07 oo-?a Area -I Employee ID# S� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De th of 3 Ft: P Sump Soil Character: <br /> COMMENTS F I��1rP b� )►SPS. <br /> PE SC ReceivedChecl Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> ya 16 ►Is 3�a Io S <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />