Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />_. ._ _......+,.. .+., CEI-n1JG.1C11TA1 14rAI TH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS /EXPIRES AR !FROM ATE 155UEuUOBADDRESS CITYIZIPCROSS STREET L� 5s APN �� 1Q~I1 0-03 PARCEL SIZEy�-^J' <br />LL- PHONE�� <br />OWNER NAME <br />OWNER ADDRES`pS r t II'U L�,'-y�^�`J` CITY/STATE/ZIP IIp/y� <br />CONTRACTOR 7 Y--�o�<+�j ��^r"C� `/��') ` Y—_ PHONE <br />CONTRACTOR ADDRESS, <br />33:24 � .J I � J C00 � I CITY/STATE/ZIPS '. Tel- <br />LICENSE <br />� qh 2 I <br />LICENSE ❑ C-42 11LC-36 OTHE NUMBER `� EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y— <br />E PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED <br />CMT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: L RESIDENCE C COMMERCIAL C OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />TERNATIVE <br />❑ <br />❑ <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG . , <br />TYPE/MFG �� — <br />DISTANCE TO NEAREST: WELL 1 ) <br />SIZE TYPE OF PUMP <br />CAPACITY G� �( �l— gal # OF COMPARTMENTS <br />CAPACITY Sm C gal # OF COMPARTMENNjTS <br />ft FOUNDATION I ft PROPERTY LINE ift <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES ft <br />LI,31slsg' <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />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 <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />MIAIIMIIM AR <br />Unt IP Ant/AIUf F AIr1T1rJ7 PFn11117F1) FnP 1M4ZP1=CTII)N4Z - P/ Fd SF rAl I /9!101 Q9;R-7RQ7 <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■liiiii■ri�1■ (��1■[�■%�■■■■■■■■I:T 1!1JI■ <br />PE SC <br />Received <br />Check#/ Amount Date <br />Permit/ Invoice # Permit ID# <br />Code INFO <br />B <br />Remitted <br />Service Request # <br />LI,31slsg' <br />-I fLl <br />1 5�2 <br />cigcl Ll <br />s x` <br />;5-7 z <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />r <br />a <br />7 <br />z <br />