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 <br />GALL Z�UY .90J -10,41.90J-10,41 FOR INSPECTIONS <br />LXPIRES 'I TEAR FROM UAIE ISSUtI <br />JOB ADDRESS /99GO SewrlY <br />SA &I f05LGRt/: <br />CITY/ZIP / -7- "cy <br />gs?4 <br />CROSS STREET g,, r"AAl <br />Y <br />APN ?o -a �i7 - 32 <br />PARCEL S <br />Vl/ <br />OWNER NAME %O4 a4 <br />%e <br />PHONE r-4Oo¢ -a <br />f <br />OWNER ADDRESS Gma#/lallIVA/ <br />43 LT <br />CITY/STATE/ZIP D0(34 <br />gIZE <br />-16/I -7A <br />Tll <br />n <br />CONTRACTOR <br />,OAR1,11-r/Ve <br />PHONE a o942 <br />5-2 <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ <br />CONTRACTOR ADDRESS O <br />?30 X Q� <br />CITY/STATE/ZIP <br />RL04K 0,4A Tr ?A <br />, <br />LICENSE 111C-42 ❑I <br />OTHER /SCC <br />NUMBER L 75*11 EXPIRATION DATE <br />nIC-36 <br />l/ �30 12- <br />DISTANCE TO NEAREST <br />W ER TABLE DEPTH: ti -7 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: I I NEW INSTALLATION LI REPAIR/ADDITION I ENGINEER DESIGNED (ALTERNATIVE <br />I l REPLACEMENT Ll OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION <br />❑ <br />SEPTIC TANK <br />TYPE/MFG <br />Date <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />❑ LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />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 />!1 <br />STATE LAWS AND RULES AND <br />REGULATIONS OF SAN JOAQUIN <br />COUNTY. <br />SIGNED <br />Application Accepted <br />Final Inspection By_, <br />Character of Soil to D <br />COMMENTS A <br />V/l IIYJr1.-Ii I IVI1117 - J-LLP1a7L IiMLL LVA VJ/ <br />TITLE /!�/L LGit//,/n/EE�2 DATE 4,1/1'/40 <br />PARTMENT VSEIONLY <br />Date Area Employee ID# Ar G- � •�i <br />Date( 3 V';6z? 2p C SPECIAL PERMIT -Approved by <br />of 3 Ft. PiUSump Soil Character: <br />PE SC <br />Code INFO <br />Received Check#/ <br />By, Cash <br />Amount <br />Remitted <br />Date <br />Permit/ Invoice # Permit ID# <br />Service Request # <br />3�7� <br />42-01 <br />4/14/18 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />