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-REFUNDABL,Ef PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS -7 4 CITY/ZIP �r C A <br /> CROSS STREET PARCEL SIZE I <br /> APN ^.��(� <br /> m <br /> S-{-.C1�1'Y►��'/� ��� — D� �. ✓J p <br /> OWNERNAME �U,L�YY?Li Y) / �j/ ,L;N 3 R{ t<C �, 77 <br /> PHONELA <br /> LA <br /> OWNER ADDRESS �I C F S• p Pl %1 G1 T� CITY/STATE/ZIP �l CI c <br /> CONTRACTOR 11��4�S GG�C(z�-G SSc�' PHONE �(',� —� !�4 r / <br /> CONTRACTOR ADDRESS �i X21 CITY/STATE/ZIP , <br /> LICENSE ❑ C-42 ❑❑C-36 OTHER - NUMBER EXPIRATION DATE „2 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# al Od q((i LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION FI ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM r! DESTRUCTION <br /> INSTALLATION WILL SERVE: LI4tSIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> {SEPTIC TANK TYPE/MFG Od L CAPACITY 6 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG y CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 16 0 7 ft FOUNDATION ft PROPERTY LINE 10 1 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> EACH LINES LEACHING CHAMBERS #of LINES _ LENGTH OF LINES 1- <br /> 0 t ft <br /> DISTANCE TO NEAREST WELL Ino f ft FOUNDATION /a ft PROPERTY LINE l(5 r 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 /> 4/-SUMPS WIDTH ft LE1NG/TTH- I LI ft DEPTH 101 ft <br /> DISTANCE TO NEAREST WELL 1 .'(l ft FOUNDATION 1 o 1 ft PROPERTY LINE IA lf" ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 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 REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR 4DVANCE NOTICE RE IRED FOR INSPECTIONS - PLEASE CALL 2 953-769 <br /> SIGNED TITLE DATE–:- <br /> ,4, <br /> ATE.S 1��1 <br /> T O C <br /> DEPARTMENT USE ONLY <br /> Application Accepted I y � 41-1 <br /> Date !I ' I Area Employee ID#�� <br /> Final Inspection By a. y,�� / Date <br /> `Y 10..1 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS J,«,YiU `-Fr. 6,)/( well <br /> PE SC Received C,Che Amount Dat Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Request# <br /> T) Nxn <br /> I <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />