Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT Q CALL 209 953-7697 FOR INSPECTIONS EXPIRE <br /> S <br /> 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Z�Z 5 • r bL�- LN. CITY/ZIP STD GK''�S►V �r Zor y <br /> 1 <br /> CROSS STREET V T� f� APN ;!-0��-/ " 0� �PyARRCEELSIZE 1`16 t p <br /> OWNER NAME A✓I c K- �`I 14 TD PHONE —i o& <br /> OWNER ADDRESS Sri V"t CITY/STATE/ZIP <br /> CONTRACTOR LI%J 0 Aje- GEd E/.M9-oWMtn/-rA L_ PHONE 3b5'oil 9 q ,` <br /> CONTRACTOR ADDRESS 40 1 ln1 • 0 O p,`_ S-17 . —CITY/STATE/ZIP L'� � GA • Y Z I4y <br /> LICENSE C-42 J C-36 OTHER C E NUMBER I EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: - RESIDENCE _I COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It 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 it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It 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 /> MINIMUU48 HOUR NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 2 953-7697 <br /> SIGNED TITLE Q CJ N'1 CV-9-' DATE 3 —9'2-1 <br /> J <br /> cyM�Nr <br /> ,q 89 2p?� <br /> pNT,j <br /> DEPARTMENT.S .2 U E 0NLY TMQjyT <br /> Application Accepted B �L Date 3 Area 9c� Employee ID#�/� <br /> Final Inspection By wy Date -/7-202SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received heck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B sh Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />