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 Cnti21PZ191-1-40-0 �0 <br /> CROSS STREET Ii_Li' �T�``//)/,,'/�1f APN o 031�a q PARCEL SIZE .�,/ <br /> OWNER NAME J�l//✓'V IAIIA"' 3�/'OS7/ <br /> cr,�7�� ,n1PHONEM <br /> OWNER ADDRESS ('�V / I) I CRY/STATE/ZIP <br /> CONTRACTOR ✓�JG/'J/J /t�S/ �yy PHONE <br /> J <br /> CONTRACTOR ADDRESS /7CU � (��u),;M CITY/STATE21P <br /> D,4-42 1S <br /> LICENSE 74-42 11C-3y6� OTHER NUMBER S/(//SE%PIRATION DATE <br /> WATER TABLE DEPTH: 13� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDrnON ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: Y-RESIDENCE COMMERCIAL�J ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: <br /> -SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY ��JJ��� gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION GCJ ft PROPERTY LINE J� fft <br /> �❑J LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> /!x LEACH LINES LEACHING CHAMBERS #of LINES LENGTH OF LINES 7 ft <br /> !/ DISTANCE TO NEAREST WELL_�UC�It FOUNDATIONft PROPERTY LINE Sd !t 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 /1 It FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER 3 WIDTH iJ' ft DEPTH 4f�1 ft <br /> DISTANCE TO NEAREST WELL7/�4R:�• R FOUNDATION flims ft PROPERTY LINE 7G//" 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 /> _48 HOU4ADY4N"NOTICE REQUIRED FOR/N (209)95j-769 <br /> SIGNED TITLE "�" DATE Zo <br /> Fc�F�IT <br /> ��VFO <br /> ZO?p <br /> P R T U E O N L Y -/�"`�C U,N CO <br /> Application Accepted By __ Date <br /> i i S .' .'L' Area -� CRC' Employee INpMENT URS" <br /> Final Inspection By j F" 5;a� r{ Date ZALra I2.0`�k I:I SPECIAL PERMIT-Approved by ARTME4 <br /> Character of Soil to Depth of 3 Ft: P t/Sump Soil Character: NP <br /> 1J /,� ,J <br /> COMMENTS�i/, ,"i Cr �'. �,e7 b r.lel�� L t rj1/r/ �'p1F�C1�FS DPI ryy^r� ren"Cjs <br /> PE SC Received Amount Date Permit/ <br /> Code Permit ID* <br /> Code INFO B Cash RemittedService Request# <br /> J i7fli 1 11-7,/l ?- *$i 5eLAP's <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />