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 C LL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2 CITY/ZIP S v <br /> n / � <br /> , APN CROSS STREET � ll�l0� PARCEL SIZEI� o <br /> 0 <br /> OWNER NAME �/J_/��.JC..� / J /•�J�I ejt:& f 4 `e, PHONE2//,Ta— 3"2' <br /> OWNER ADDRESS ziC.YS / / !/�f(/I��z CITY/STATE/ZIP <br /> CONTRACTOR' �iw-�`/ S (//�J)iS/���� K L�• PHONE <br /> CONTRACTOR ADDRESS Zh:C L _ �/// L4Z 12- L CITY/STATE/ZIPdn�) y <br /> LICENSE ❑OC-42 ❑LC-36 OTHER /�I NUMBER d�6 EXPIRATION DATE /21 7 l .-,L.'2i <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COO r I ates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# o LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION R AIR/ADDITION I_I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG / 1,� CAPACITY D gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LltfLs- LENGTH OF LINES `�" , ft <br /> DISTANCE TO NEAREST WELL OD l ft FOUNDATION lb 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 PAYM16 RIT <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tj, <br /> C�- SUMPS WIDTH 6V ft LENGTH z ' l l ft DEPTH /� 'ff`"/ D <br /> DISTANCE TO NEAREST WELL 'I';-t) ft FOUNDATION ft PROPERTY LINE juL W2 21 <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft L <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE SAN JOAQUINfC UNTY <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH <br /> ENVIRONM N AL <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 1119 TIAENT <br /> i HEREBI(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 /> INIMU 48 HOUR AQUANCE4VOTICE IJEQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED. TITLE L D DATE <br /> A'-V41 Ile <br /> 17 <br /> EPARTMENT USE ONLY <br /> Application Accepted Date Area Employee ID#a. R7 rurVSa�s{/' <br /> Final Inspection By Date ❑ SPEC AL PERMIT-Approved by <br /> Character of Soil to epth of 3 PiUSump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount ate Permit/ Invoice# Permit ID# <br /> Code INFO By Remitte ervice Re uest# <br /> 1.�Csh. <br /> `i ►s Zi ncf 611- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />