Laserfiche WebLink
k <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-KEFUNDyABLE rERMIT`' (:ALL (ZUy) YbJ-/6y/ FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS 17 <br />3 7 N • T�¢ Er9ev1*V RoA <br />D CITY/ZIP L'qiD <br />j 95A3 <br />CROSS STREET <br />,S. / <br />1'! Wy (f1 <br />APIN 0.57- 1 J - (4. �7 <br />SIZE ??Ae <br />OWNER NAME_ 11,4 <br />/ <br />1- LEPPLLEV <br />WIDTH <br />'PARCEL <br />Q� <br />PHONE P�7�GG3.777� <br />OWNER ADDRESS <br />7/,Z ¢ O5rA c &,P - <br />CITY/STATE/ZIP <br />CONTRACTOR�GS/VE/ <br />/1-1 <br />GO/�IS(iCL�/��f <br />PHONE <br />02-- <br />CONTRACTOR ADDRESS <br />f 0. FOX, <br />CITY/STATE/ZIP <br />T//iIALO4k_'A 9s%Bl <br />LICENSE ❑LIC -42 <br />❑❑C-36 OTHER �(%E <br />NUMBER ,f �7 EXPIRATION DATE <br />G�3T <br />W TER TABLE DEPTH: ti 0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # 1 BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: 1-1 NEW INSTALLATION LI REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />C 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 <br />❑ GREASE TRAP TYPE/MFG <br />CAPACITY <br />CAPACITY <br />DISTANCE TO NEAREST: WELL ft FOUNDATION _ <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br />Received <br />By <br /># OF LINES <br />LENGTH OF LINES ft <br />Date <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />It PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />-R.00�441(v <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />I HEREBY CERTI HAT I HAVE P EPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />n <br />STATE LAWS AND RULES AND <br />REGULATIONS OF SAN JOAQUIN <br />COUNTY. <br />SIGNED <br />wrx IIYJrCLo l IWIVO - 1-LCHJC ld-ILL I Avid <br />TITLE CJ(/L gdgG,j /O DATE �d <br />/ DEPARTMENT USE NLY <br />Application Accepted By — L% Date ) Aa G' 'd Area Employee ID#Fig_ <br />Final Inspection By i y Date_ . +L ti 1(q � ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 t: Pit/Sump Soil haracter: <br />T <br />SPMENTS ror rg, t hF w / G V d t L <br />y <br />.`7 3 �wlw, 0.�1� = L • j wt 1� l�I �.L i ��w j i %c�5�ti�-f 4� c-zj f,,L>, " <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check <br />Amount <br />Remitted <br />Date <br />Krit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />y as a <br />sa 3 <br />760 <br />-R.00�441(v <br />42-01 <br />4/14/18 <br />ONSF W STEWAT TRTMNT SYSTEM PERMIT <br />