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 JPERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Ire _ / 4 ^d !4Wq__Ze4 CITY/ZIP <br /> CROSS STREET // � y L ` APN 0R1 7 I L! PARCEL SIZE 3►`f __ p <br /> C <br /> OWNER NAME G7� PHONE J <br /> n <br /> OWNER ACDRESS rJC CITY/STATE/ZIP <br /> CONTRACTOR q/lq �J PHONE �Ct � �/ may. <br /> CONTRACTOR ADDRESS .g t/ ' ' ��'"�- ' CITY/STATE/ZIP 1 F YI. ✓��__ _ <br /> LICENSE 1 XC-42 1 I C-36 OTHER _ NUMBER tJ�J EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> l I PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 1 1 COMMERCIAL L 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 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP_ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS /2' J #OF LINES - �) LENGTH OF LINES 5 ft <br /> �1 f �� ��YJ,vr9� � <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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/Fnt ir.inATION ft PROPERTY INF ft <br /> SUMPS WIDTH r / <br /> ' ft LENGTH Tpft DEPTH_ &,1 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ 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 /> h1INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED - v TITLE L! l' r _. DATE <br /> - +r^� <br /> 7 f <br /> 1 <br /> j A <br /> Lj'j'ARTj6fE1 <br /> �r DEPARTMENT USE ONLY <br /> Application Accepted ' // — Date :Ss Area Employee ID# <br /> Final Inspection By f _ uaie � PECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil C racter: <br /> COMMENTS Fe uYe b� Imes osS L) 'ri fr,, )oYl e 2 tI l r, 6einq done. WeB j 'YR Uc;I <br /> c,I I _e r secf1py, y,e 5 vii < 2e.L Fn G <br /> S - S 71 <br /> PE SC Received Chec Amount Permit/ <br /> Code INFO B ash Remitted Date Service-Request# Invoice# Permit ID# <br /> 'n Igy <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />