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 FORINSPECT/ONS E <br /> �XP <br /> IRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ZSy O I Ar <br /> -�I� 4 <br /> . ` yT7�� <br /> /V ' CITY/ZIP �4e f� Pe) ti.Ty ZO y <br /> CO L�1 APN D Z 1 —()36 I PARCEL SIZE G A, m <br /> CROSS STREET �•O Art- <br /> 0 <br /> 0 <br /> , L <br /> OWNER NAME �&Ipr,p1,1-1 w A��- C R-u m^E� PHONE 3 2 7' S3 6 j <br /> OWNER ADDRESS Sol V"C CITY/STATE/ZIP <br /> CONTRACTOR L.1\ft� �D{, CIL �T�%�N� ah�����7� L PHONE 3��J X31 <br /> CONTRACTOR ADDRESS -l 0� w• 0 A I�' `ST' CITY/STATE/ZIP Lot'-#( CA 9S2-YO <br /> LICENSE E C-42 ❑i.C-36 OTHER C E.C7. NUMBER 7-15-1 EXPIRATION DATE 4+-30-2--L <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 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 i' DESTRUCTION <br /> INSTALLATION WILL SERVE: - RESIDENCE 0 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 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE44 <br /> 13FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ^ C <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 4D 2 n <br /> L3SUMPS WIDTH ft LENGTH ft DEPTH '34AI iI.ft Z�120 <br /> , <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE `t Q /N <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTHII�FN�� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE gRTM C <br /> El SEEPAGE PITS NUMBER WIDTH ft DEPTH n FNT <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 /> MINIMUM49hldlRADV4=NOTICE R IRE INSPECTIONS-PLE E CALL(209) - 7 <br /> SIGNED TITLE �2Dj' W1G�Q ' DATE <br /> DEPARTMEN U E ONLY �� <br /> / I i <br /> Application Accepted Date J� �J Area CACI Employee ID# <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 t: Pit/SumP Soil Character: <br /> COMMENTS S <br /> 0. SRIPL;kz <br /> PE SC Received h Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO ash Remitted Service Request# <br /> Lima d sa I s 2 U <br /> y <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />