Laserfiche WebLink
S <br /> r" <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 <br /> �PERMIT q CALL /209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> / <br /> JOB ADDRESS I r l r /V i .S An M -6 l 1- A CITY/ZIP <br /> Co <br /> /� T <br /> CROSS STREET //�Qt- A U 2 APN � 171 8 s001 PARCEL c/SIZE <br /> ' <br /> OWNER NAME J/�.V/ T, C /L PHONE�� <br /> ! <br /> OWNER ADDRESS -J �, 1 J �L ( L` CITY/STATE/ZIP <br /> CONTRACTOR DvJd'p>' PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE 1111C-42 11I-IC-36 OTHER NUMBER 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 I-.I ENGINEER DESIGNED/ALTERNATIVE <br /> ii REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM XI DESTRUCTION S/'ptf< }G7►�� <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 /> ❑ 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7nn697��77/,-� <br /> SIGNED � � G TITLE O(,-We-`' DATE CJ�`�ol�f� <br /> / I <br /> SA 0 <br /> PT E T <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By A Date I I 0 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS CX Tesicierce. yj 11 s "tee,' NO f u� rInF <br /> n �✓ <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Ca Remitted Date S vice RvnelPst# Invoice# Permit ID# <br /> .IA. 11 o7s" #I -d 11 w g <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />