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-REFUNDABL IyMIT C LL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 86 )ZO 3 �� / CITY/ZIP <br /> CROSS STREET— f 0 f ` APN �_` / J(/�+ 7� PARCEL SIZE /T d <br /> OWNER NAME ) l�- �/ _ �tV�`N /per-PH�O�NE/ 41 <br /> r1 Vx" <br /> OWNER ADDRESS ry 1.`` l �I, CITY/STATE/ZIP �Clt <br /> CONTRACTOR er bf1Z;lfT Cz'J17S/ IUB'/ �On PHONE <br /> CONTRACTOR ADDRESS P- cl)z ISJ6 CITY/STATE/ZIP <br /> LICENSE 11❑C-42 110C-36 OTHER NUMBER O� L EXPIRATION DATE <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 IJ ENGINEER DESIG ED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ 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 /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES 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 /> ❑ 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 /> U SEEPAGE PITS NUMBER DTH ft DEPTH ft <br /> DISTAN TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HERE Y CERTIkTHAT E PR ARED THIS APPLI ION ND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAW ND R LES AND REGl1LATIONS F SAN JOAQUIN COUNTYINIMOUR A 9/AN NO RE ED FOR 1 SPE NS-P ASE Q, 20 51-M <br /> SIGNED TITLL261 DAT <br /> 6N O <br /> VI p <br /> oe DEPARTMENT USE ONLY ri EPART <br /> Application Accepte By �- C�� Date Area -� Employee ID# <br /> Final Inspection By Date,% 1,\n 11�'(�L ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS -6ar-P,fZC--p bl-AMI? Srdo �7-3164Z�.r.,a <br /> PE SC Received Check# Amount Permit/ <br /> Code INFO B ash Remitted Date ervlce Re uest# Invoice# Permit ID# <br /> Haa Iods lsa <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />