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-KEFUNDA LE PERMIT <br />(:ALL ZUY Y0J-f0,4/ FOR INSPECTIONS <br />CXPIRES I FROM DATE ISSUE <br />JOB ADDRESS <br />Q � <br />CITY/ZIP <br />�JYEAR <br />i Q O 5 <br />3 <br />CROSS STREET <br />APN <br />/ C) / <br />PARCEL SIZE y <br />/� r(� l� S <br />_( �9' l� 2 -Z <br />OWNER NAME • f1,('i <br />"� <br />PHONE 1� - <br />/_ Q y <br />�i <br />CS <br />CITY/STATE/ZIP <br />— <br />�� 2-6 <br />OWNER/r1 <br />OWNER ADDRESS V /� <br />n Gl <br />I <br />�W <br />PHONE <br />CONTRACTOR ADDRESS PQ <br />v <br />CIT/STATE/ZIP <br />gmy <br />LICENSE ❑OC -42 ❑FIC -36 OTHER <br />NUMBER <br />EXPIRATION DATE <br />J� <br />0A 2, <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # d I O d 3S 3 LAND USE APPLICATION # <br />TYPE OF WORK: q NEW INSTALLATION ❑ REPAIR(ADDITION I I ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM i I DESTRUCTION <br />INSTALLATION WILL SERVE: I RESIDENCE ❑ COMMERCIALEl OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: /) _ NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />CAPACITY <br />CAPACITY <br />DISTANCE TO NEAREST: WELL )0 <br />f ft FOUNDATION S / <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT <br />LEACH LINES <br />❑ FILTER BED <br />❑ MOUNDED <br />❑ SUMPS <br />LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL Z / V ft <br />ft LENGTH <br />WELL <br />ft LENGTH <br />WELL <br />ft LENGTH <br />WELL <br />gal # OF COMPARTMENTS4-- <br />gal <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE PDr ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />_ # OF LINES �/ LENGTH OF LINES S.5 ft <br />FOUNDATIONIt PROPERTY LINE 87 ft <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft FOUNDATION <br />ft DEPTH It <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL �7 ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER L WIDTH .7 (11/' ft DEPTH 36 /, ft <br />DISTANCE TO NEAREST WELL Zb 9 ft FOUNDATION I) ft PROPERTY LINE/ ? i I 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 />DEPARTMENT USE ONLY <br />Application Accepted By Date Area `7 Employee ID# <br />Final Inspection B Date I n (7 c ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Pit/Sump Soil Character: <br />COMMENTS SeCOY161 SFP-- 7IPy Le";cY j►h-e U'�tJ 12)J-5 PIV L be cyf) `em b'& <br />Amount Date <br />PE SC Receivedrsh <br />Permit/ Invoice # Permit ID# <br />Code INFO BR Remitted i I <br />Seryice Re uest # <br />V <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/16 <br />