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 -REFUND BLE PERM T f,fCALL 953-7697 FOR INSPECTIONS EXPIRES 1 Y R FROM DATE ISSUE[ <br />JOB ADDRESS ` -1� _ CRl'ZP _ 1 (/•�; <br />LA <br />CROSS STREET c / �}�` `l/Ahe:M �J I 1) LXA"PN CQ If- __ (.r _PARCEL SIZE _ • L/ _ <br />OWNER NAME�JTV �aIC�3I`rl./i�1 _ PHONE�y___ <br />OWNER ADDRESSS/�/CS _ CITY/STATE/ZIP <br />CONTRACTOR D • A ' � �ti.� "• �/� 1�+�� _l /�C )_ PHONE �,6 -706C7 <br />70 {�'7'�{ ///��T ///��� <br />CONTRACTORADDRESS _ N_ � �.JAH—CITY/STATE/ZIP j� d D� l5� <br />LICENSE XC -42 .,C-36 OTHER --A------ NUMBER _ 5�I 1111 EXPIRATION DATE_ t `� 5_ <br />WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST K _ BUILDING PERMIT # _ _ _ LAND USE APPLICATION <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESI /AL RNATIVE <br />REPLACEMENT _ OUT-OF•SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: __ __. 3- __ NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG — _ <br />CAPACITY <br />gal k OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />_. CAPAI'I!Y <br />gal 90FCOMPARTMENTS_ _ <br />FILTER BED <br />DISTANCE TO NEAREST: WELL _ _ <br />_ _ It FOUNDATION _ <br />_ ft PROPERTY LINE _tt <br />❑ LIFT STATION <br />SIZE __. _ _ .._, TYPE OF PUMP__,___ <br />_ ❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />IL LEACH LINES <br />C ' <br />1CLEACHING CHAMBERS p k OF LNES <br />/� <br />LENGTH OF LINES � 0 It <br />LL <br />DISTANCE TO NEAREST WELLw± It FOUNDATION.--.-tT <br />_ft PROPERTY LINE c J+ It <br />O <br />FILTER BED <br />WIDTH ft LENGTH _ _ ft <br />DEPTH It <br />DISTANCE TO NEAREST WELL___ ft FOUNDATION _____ _ _ <br />R PROPERTY LINE It <br />❑ <br />MOUNDED <br />WIDTH _ It LENGTH It <br />DEPTH It <br />, ,,[ <br />DISTANCE To NEAREST, WELL It FOUNDATION <br />z <br />It PROPERTY LINE It <br />y <br />SUMPS <br />WIDTH L1_i tt LEEGTH 1 ft <br />DEPTH � 1 ft <br />DISTANCE TO NEAREST WELL _I��_ Il FOUNDATION __ <br />fI PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH _-_-__— It LENGTH � ft <br />DEPTH It <br />DISTANCE TO NEAREST WELL It FOUNDATION _ <br />ft PROPERTYLINE_ ft <br />❑ <br />SEEPAGE PITS <br />NUMBER_,_.._. WIDTH_ft <br />DEPTH If <br />DISTANCE TO NEAREST WELL---- It FOUNDATION <br />It 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 />vn N r JV Y LCHJC IrHLL 7Uy yJJ-/t)J <br />c <br />TITLE DATE – J <br />DEPARTMENT USE ONLY/. /� <br />Application Acce '� • _ Date G 1 Area .19..(Z`�� q�j Employee IDk SGe HA <br />Final Inspection B / - Date _�/ O SPECIAL PERMIT -Approved by <br />Character of Soil to epth of 3 Ft:^F(It/Sump�Soil Character: <br />COMMENTS -A&^; ./.I 1d4�LO 4" &U �,, dtc L fi tea ' •il, <br />7� �n GE/�r aha y✓L�l �% T;^f3� Kx - .c i°�71c•4s I�4c rG.�Gclss� <br />4//7L1 LY2% <br />Date Invoice k Permit IDM <br />Code INFO By, Remitted Service Request k <br />J J�I .. r- �� ' I -Y4-1) I A � n — I Ci/i A C 1 -e',2 , — / I <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />424/12 <br />