Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> y fxN 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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1:71 t-5 1�1 -6 �( <br /> V k CITY/ZIP , Z/ <br /> ri <br /> CROSS STREET I¢.{ APN a o PARCEL SIZE�O a C' - C <br /> Atli —SZ�~ -- <br /> OWNER NAME n�� (i CO PHONE n <br /> OWNERADDRESS (� 1 1� _CITY/STATE/ZIP <br /> CONTRACTOR J4. 1- Ytr"1 1) <br /> y , PHONE q)0:265-- <br /> CONTRACTOR <br /> )02 Gj� <br /> CONTRACTOR ADDRESS N 'w, p�'� CITY/STATE/ZIP K*Ick '� 95:7 4 <br /> 5:7L <br /> L <br /> LICENSE ❑CIC-42 ❑f.IC-36 OTHER CleQ NUMBER `:7EXPIRATION DATE DZ C_ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: CI NEW INSTALLATION I I REPAIR/ADDITION I ! ENGINEER DESIG ED/ALTERNATIVE <br /> I_i REPLACEMENT CI 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 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES I' 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 /> EI 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 /> 1 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 /> MINIMUW48 HOJJR AQUANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 9C5�3 7697 <br /> SIGNED TITLE fZ7 DAT 1 [J <br /> AD <br /> IN CC JNTY <br /> EVIOMN <br /> PARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date Z Q v ❑ SPE ALP MIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Wo QJrvqP '){- u- oed. IZIo71-7-0 <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> � o c yz, s►2, IL-j <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />