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-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �nSS BKONSln CK 001-ID CITY/ZIP MIqfJTE(A CA 4533 <br /> CROSS STREET FIZnNTgGE APN I9-3 PARCEL SIZE <br /> 0 <br /> ` a <br /> OWNER NAME (3IE MMIrV L.DPF"7 a eTE a A PHONE(20{12-32-2iRq U <br /> OWNERADDRESS SDOyirjEy14f2D FbIkrr L. CITY/STATE/ZIP SIALlOA ., CA R53(,h° <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑!'C-42 ❑i C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: S ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# 9 0 CUTP2 LAND USE APPLICATION# <br /> TYPE OF WORK: A NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> ItNU <br /> LATION WILL SERVE: ■ RESIDENCE [ICOMMERCIAL El OTHER <br /> MBERR OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ■ SEPTIC TANK TYPE/MFG FQ5CA`-V CAPACITY 2'000 gal #OF COMPARTMENTS 2- <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 LINESy LENGTH OF LINES 00 ft <br /> I'HOMe I <br /> DISTANCE TO NEAREST WELL Q5 5 ft FOUNDATION 3I ng 6VIrDn+c ft PROPERTY LINE ( J 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 209 953-7697 <br /> SIGNED TITLE oySNG(L DATE 311 3 j;,n <br /> 400 <br /> FINT <br /> VEh <br /> 15A N <br /> A <br /> N4EI ITA <br /> MN <br /> DEPARTMENT UjSE ONLY f� <br /> Application Accepted By / Date 3 -1 -Lz)G,D Area Employee ID# D, <br /> Final Inspection By 1 Date " ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS S& DO Y/6 t? 1P �C k"C ess f4,7 Ir;nAhch <br /> PE Sc Received N4CJuwWr Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted IService Request# <br /> ya 1) 7 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/16 <br />