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 FOR INSPECTIONS EXP1^ ) <br /> IRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS / / t • J l CITY/ZIP C l r �' ' 4 <br /> }- < <br /> CROSS STREET � J`' 1 It�V^ 1 J �4 1 101&1 APN PARCEL SIZE 0 O <br /> v <br /> OWNER NAME '�)O Y PHON� / <br /> OWNER ADDRESS i2q 9 y 1, <br /> CITY/STATE/ZIP C <br /> CONTRACTOR 1�I10 <br /> D 10 <br /> I A <br /> CONTRACTOR ADDRESS CITY/STATE/Z <br /> �N@W�ma have e2111RA , wi0 <br /> LICENSE ❑ C-42 ❑. C-36 OTHER PIRrAfIQ�I�TO�f+a•G An <br /> 1 `'' LL�!�rrl {1II''II��1(�Jni' <br /> WATER TABLE DEPTH: �V u ft GEOGRA HI tltJtl f;j� gauui tell 7C Y <br /> ❑ PERC TEST # BUILDING PE IT# 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: n RESIDENCE Ll COMMERCIAL Ll OTHER <br /> NUMBER OF LIVING UNITS:_/AA9II NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: �J - <br /> I„ SEPTIC TANK TYPE/MFG V4/ 1.-, CAPACITY gal #OF COMPARTMENTS v. <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> �A�I <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 /> f LEACH LINES LEACHING CHAMBERS #OF LINES 27 LENGTH OF LINES �1 ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION_(01 f" It PROPERTY LINE T ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> �j DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> L� SEEPAGE PITS NUMBER WIDTH �-7ir� 1ST DEPTH ZS ft <br /> DISTANCE TO NEAREST WELL._ ft FOUNDATION ((�f-F It PROPERTY LINE 5� 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 /> MI'MMUM24 HOUR ADVANCE N TIC REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 / <br /> SIGNED TITLE _'4 l I.k ✓ )_1 DATE <br /> all J <br /> T juvfl <br /> Le g) <br /> n e ` ka <br /> ng <br /> v ro <br /> N �a <br /> ` Fn, <br /> AZ�"L___LPARTMENT USO NLY <br /> Application Accepted By Date ?� Area Employee ID# Sib LUS <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC ReceivedCheck#/1 Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B "Casts" Remitted Service Request# <br /> p vi A09 L <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />