Laserfiche WebLink
ONSrrE 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 20 )953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP <br /> CROSS STREET � � APN V 0 �3 WAL ,'rLE �j <br /> d <br /> OWNER NAME p �A, ZZ oJ)�14,1 PHONE , 1612 <br /> OWNER ADDRESS` CITY/STATEIZIP <br /> CONTRACTOR / PHONE �1gr <br /> /JJ <br /> CONTRACTOR ADDRESS ��� / /T'�/ �i� CITYISTATEIZIP <br /> LICENSE ❑LIC-42 ❑UC-36 OTHER_ NUMBER �Q_2&EXPIRATION DATE��Z <br /> WATER TABLE DEPTH: UP -13 b ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: C NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> Ll REPLACEMENT ll OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: q NUMBER OF EMPLOYEES: <br /> U 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 /> I] LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> IN( LEACH LINES ❑ LEACHING CHAMBERS #OF LINES�� LENGTH OF LINES y/� / ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION—ft PROPERTY LINE ft <br /> ® FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> CSI MOUNDED WIDTH ft LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Fa SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTH .2 J ft DEPTH _ , ft <br /> DISTANCE TO NEAREST WELL.. ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 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 /> MINI M 48 HOU ADVA CE NOTICE REQUIRED FOR INSPI=CTIO�>NS-PLEASE CALL 209 953-76917 <br /> SIGNED TITLE C/ DATE <br /> L. ,+ <br /> rlvr <br /> OQ <br /> H T <br /> DEPARTMENT VSONLY <br /> Application Accepted Bv Date 0,-'b A,,..re��a��� 7% Employee ID# it <br /> Ly <br /> Final Inspection By Date zt7 iJNtCIAL PERMIT-Approved by t+ <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS e S �,.Ipn In he vj )rfer l gW hheS ee, <br /> e0ftenI se�bhck r !r en L _ icedrs —S <br /> PE SC ReceivedC cl Amount Permit/ <br /> Code INFO By Cash Remitted Date Service Re uest# invoice# Permit ID#— <br /> Nala i►s !,P> as <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />