Laserfiche WebLink
PV <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> N COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> -FUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> r to <br /> JOB ADDRESS E) (` CITY/ZIP -C J <br /> CROSS STREET ___ APN O,J(�`��/�3o— �J PARCEL SIZE <br /> OWNER NAME h ` PHONE <br /> OWNER ADDRESS _- l� _ ( CITY/STATE/ZIP Q Q1 <br /> CONTRACTOR w � v� ` " <br /> PHONE90 <br /> CONTRACTOR ADDRESS CITY/STATEIZIP <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHERGle�ct'A- NUMBER 9-ki EXPIRATIPNDATE �0 001 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: oordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT U OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 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 /> 46 LIFT STATION SIZEU_G-6� TYPE OF PUMP v ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> " ls d <br /> 0 LEACH LINES 1 LEACHING CHAMBERS #OF I-INES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> l_? FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I� MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH 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 it 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 /> MIN/Ad,W 48 14OUR ADVANCE NOTICE REQUIRED FOR IN P CTIONS -PLEASE CALL 209 9a3-7697 <br /> lk <br /> SIGNED TITLE DATE <br /> __4—pAlf A <br /> inn <br /> Q i Cou <br /> T AL <br /> EPARTMENT USE ONLY <br /> Application Accepted Uater Area Employee ID 4__ <br /> 14 /I i -"Ad.4— <br /> Final Inspection By Date 24l20SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Ch racter: <br /> C,QMM TS CD)19ZCt '�'o (S S S O <br /> t'�r ►' r U/ ' I� -rF <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> If 2-1 <br /> 42-01 Ly <br /> 4/14/18 I rt/'l S 'o'w ���� �� G� �O^ I �n ONS STEWTM Y; MI�__!� <br />