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 />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />CALL 22s09 953-7697 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS ,�T� f/ <br />LAND USE APPLICATION # <br />r / <br />FSI F / dL <br />t jAQ0j i L- ! � -ads <br />REPAIR/ADDITION <br />ENGINEER DESIGNED /Al TTERNATIVE <br />�7 �7CITY/ZIIP� /�54 <br />I. 9 (1 <br />1� <br />I <br />CROSS STREET S/ -C-1 <br />DESTRUCTION 11 F. <br />APN i 1 T `� <br />PARCEL SIZE I I <br />OWNER NAME Su[LYt <br />51�' 4].L�fire[ <br />NUMBER OF EMPLOYEES: <br />7 <br />E/���� Ste-7� <br />OWNER ADDRESS I' D V <br />CAPACITY <br />f^�/ cii/(—PHHO�N�-r <br />FwF44;1 d% Ow CITY/STATEIZIP 5 <br />r1 C ii <br />CONTRACTOR <br />CAPACITY <br />PHONE <br />❑ MOUNDED <br />CONTRACTOR ADDRESS <br />It FOUNDATION <br />CITY/STATEIZIP <br />❑ LIFTSTATION <br />LICENSE ❑_C-42 ❑ _C-36 <br />OTHER <br />NUMBER EXPIRATION DATE <br />DISTANCE TO NEAREST <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />❑ PERC TEST # <br />r BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED /Al TTERNATIVE <br />ft FOUNDATION <br />_ REPLACEMENT _ <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION 11 F. <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ MOUNDED <br />DISTANCE TO NEAREST: WELL <br />It FOUNDATION <br />It PROPERTY LINE it <br />❑ LIFTSTATION <br />SIZE TYPE OF PUMP <br />❑ PKGTXPLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />f 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 />❑ FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />It <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />It PROPERTY LINE It <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />It 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 />Ut YAK/Mtrvl U CVrvL1 ��i ��T/Mp <br />Application AcceptecLBy Date Area `C Employee ID# (V/tG�J CNT <br />Final Inspection By ITU:. Date ❑ SP IAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS �n�/I h 0 G �n ; -4-1 i < P txl bn /1 oLA ( Yb y <br />F Lid vtd±E 5- i t C01 0 E4IW4 4e f? d <br />PE SC *Received heck Amount Date PermlU Invoice # Permit ID# <br />Code INFO ash Remitted Service Re uest# <br />01 OIsIS <br />42-01 n / � J�zqbqa34 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14!18 Iv-F,�'• <br />