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 />NUN-KtFUNUAtiLL r�t:KMIT (.ALL <br />LUJ JOSH-f0.4f FOR INSPECTIONS <br />'I YEAR FROM UATE ISSUEI <br />JOB ADDRESS _ _ _ c <br />Cr / V a <br />� 1"-T I ,? CITY/ZIP Vq <br />�t"XPIRES <br />�1wl <br />50. ✓ !7 f C� <br />CROSS STREET <br />�/` _` <br />JA4 ("! h [ - h� Y_ }� <br />A P N f� f <br />PARCEL SIZE i ✓ <br />/rn <br />OWNER NAME K9 <br />Cf br e f ye- - <br />TYPE/MFG C�Y1G/e //" P c CAPACITY l d c' 0 gal # OF COMPARTMENTSy <br />PHONE <br />OWNER ADDRESS 1 <br />"� "-JE��I, '7D <br />CITY/STATE/ZIP <br />/ <br />`9�• �/ <br />i r i <br />DISTANCE TO NEAREST: WELL ft FOUNDATION /Q ft PROPERTY LINE CIO ft <br />CONTRACTOR <br />C <br />`l V �� I "�/ <br />PHONE <br />��7��15 <br />CONTRACTOR ADDRESS <br />/%��/__'� <br />.3 �q fTJI/.l*C�l✓I <br />,(� ,^ /� <br />/K P� CITY/STATE/ZIP <br />DISTANCE TO NEAREST WELL �?00 i ft FOUNDATION :,?U ft PROPERTY LINE /00 r ft <br />❑ <br />LICENSE ❑KC -42 ❑ <br />C-36 OTHER <br />NUMBER 7��U7 EXPIRATION DATE <br />7 <br />ia/J3 <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />WATER TABLE DEPTH: i3�`: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ <br />PERC TEST # <br />I BUILDING PERMIT# QQQOV o2 LAND USE APPLICATION # <br />TYPE OF WORK: <br />Aj NEW INSTALLATION REPAIRIADDITION 11 ENGINEER DESIGNED /ALTERNATIVE <br />00 i <br />F-1 REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION <br />INSTALLATION <br />WILL <br />SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS:/^I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />,C{ <br />SEPTIC TANK <br />TYPE/MFG C�Y1G/e //" P c CAPACITY l d c' 0 gal # OF COMPARTMENTSy <br />( ❑ <br />GREASE TRAP <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />i r i <br />DISTANCE TO NEAREST: WELL ft FOUNDATION /Q ft PROPERTY LINE CIO ft <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />i <br />LEACHING CHAMBERS # OF LINES LENGTH OF LINES s S ft <br />DISTANCE TO NEAREST WELL �?00 i ft FOUNDATION :,?U ft PROPERTY LINE /00 r ft <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS <br />NUMBER % WIDTH Z d/ ft DEPTH ft <br />DISTANCE TO NEAREST WELL -%O ft FOUNDATION V O ft PROPERTY I INF /cc 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 />Final Inspection By Ir/`dn! �[t w. L'c- �`r�2 Date `i(1 �f �2( ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Ne'lvj s r I 11 Fr _ <br />PE SC Received Check <br />Code INFO By ash <br />Amount Date <br />Remitted <br />Permit/ Invoice # Permit ID# <br />Service Request # <br />9) 11 1 72 <br />S�1 ? <br />00 i <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />T <br />