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 Z .1 /O 1'(�APD)- L' eL'�K IN Cm'21P L O D I <br /> ,,r <br /> CROSS STREET ^,ypLL L T/ 6 6 APN 0 1 ( 0 PARCEL SIZErt-� o <br /> OWNER NAME r•v` CPc QUO L—L PHONE -7�� 5 !(0S <br /> OWNER ADDRESS S pcv�G CRY/STATE/ZIP q -T <br /> CONTRACTOR—LII lT�O EN�1 ecD AJ�E/V I F�L PHONE__5&D / - 0-3 I C, <br /> CONTRACTOR ADDRESS "i'AJ w' O IcIrIC 'T- CrFY/STATE/ZIP Lep, ` <br /> _3Q-WLICENSE ❑i::IC-42 110C.36 OTHER CEG NUMBER Z�5 I EXPIRATION DATE 4-30- <br /> WATER <br /> ATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> T PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION C REPAIR/ADDITION C ENGINEER DESIGNED/ALTERNATIVE <br /> 11 REPLACEMENT 17 OUT-OF-SERVICE SEPTIC SYSTEM C DESTRUCTION <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 C7 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 It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It 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 448�?OUR ADVAWCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED i'C%� '��`�[ TITLE �"rezJ DATE `4- 1'4 �'1 <br /> 1 <br /> t <br /> I <br /> IQ�(y <br /> DEPARTMENT USE ONLY <br /> *;, <br /> F,gRT <br /> Application Accepted By Date Area y/C(G Employee ID# D, MFNT <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO BY ash Remitted I I Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />