Laserfiche WebLink
t <br /> 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 XPIRES 1 YEAR FROM DATE IS/SU/ED <br /> JOB ADDRESS �' CITY/ZIPS I P(',) 6 <br /> f S 6 _v: <br /> CROSS STREET �.'T��� �C �� �j� APN Z Ce J O �� L PARCEL SIZE v� 3 <br /> F n z <br /> OWNER NAME {A 1� � Q �•, � r� �/e� PHONE <br /> OWNER ADDRESS /��/3 S '��'-1 CITY/STATE//ZZIIP <br /> An <br /> CONTRACTOR �ITL} ) t° PHONE { ! �� �// 3^^� -j- <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS ,z C/ G�N��I �`�I L�/' CITY/STATE/ZIP <br /> 0 <br /> LICENSE 11L'C-42 1111C-36 OTHER / 1 NUMBER�(' 3 Ci , 3 EXPIRATION DATE �/ 3 w- I <br /> WATER TABLE DEPTH: �.y0 ' ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# S LAND USE APPLICATION# <br /> TYPE OF WORK: w! NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> CI REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE C COMMERCIAL C OTHER <br /> NUMBER OF LIVING UNITS: }} / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ® SEPTIC TANK TYPE/MFG ��G C J.L�l� �� CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATIONft PROPERTY LINE ��' .I ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 4' LEACHING CHAMBERS C,) 3 L #OF LINES LENGTH OF LINES IV I) ft <br /> DISTANCE TO NEAREST WELL 0 ft FOUNDATION Z ft PROPERTY LINE J t ft <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 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 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 /> MINIMUM 48 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 <br /> SIGNED TITLE �.i�'/hf cJ^ DATE /1Z 2—(-1P v <br /> Irk <br /> U '71 19f <br /> WIN ry A <br /> N <br /> rA <br /> ,� / DEPARTMENT USE ONLY <br /> Application Accepted � / - L— Date 11 Ih0 volb Area l 7 Employee ID# (� <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to epth of� Pit/Sump Soil Character: <br /> COMMENTS �Je l,j -,,- FP-. : er -1 • 6 i� w J(' 0 ct }Lfc%s 12EK 6m'Y1 7 I P'''Qrd-s- <br /> PE SC Received hec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By sh Remitted ervice 5,egyest# <br /> ya13 Ii7s IU �o <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />