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 GALL (ZUY) 9t)J-1tiY1 FOR INSPECTIONS tXPIRES 1 YEAR FROM DATE ISSUE] <br />JOB ADDRESS 51 1 ) CITY/ZIP 41 rl &4 A G!% <br />CROSS STREET et l�` KLt.(.(/ APN L �� --' ('3 (O� PARCEL SIZE <br />OWNER NAME Lui S 0tyz /�rz Q PHONE <br />OWNER ADDRESS("Fv(/'i[�V �^��/� CITY/STATE/ZIP] <br />CONTRACTOR ISIS S� c/ <br />rt PHONE <br />/I �� }, <br />CONTRACTOR ADDRESS � &)c 6 CITY/STATE/ZIP �L�L%lig / Gr/Y' <br />LICENSE ❑0C-42 ❑0C-36 OTHER NUMBER EXPIRATION DATE ; a5 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT #�� LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION r I REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT ❑ OOT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: `P -RESIDENCE ❑ COMMERCIAL, ❑ OTHER <br />NUMBER OF LIVING UNITS: ` NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY /CP a a gal <br /># OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY gal <br /># OF COMPARTMENTS <br />WIDTH <br />DISTANCE TO NEAREST: WELL I �d I <br />ft FOUNDATION a n, ft <br />PROPERTY LINE 401 ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />❑ LEACHING CHAMBERS <br /># OF LINES �-I LENGTH OF LINES CD ft <br />Check#/ <br />Cash <br />DISTANCE TO NEAREST <br />WELL[nbt ft <br />FOUNDATION to I ft PROPERTY LINE /Q / ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />0/ SEEPAGE PITS <br />NUMBER WIDTH '3" 1I <br />ft DEPTH �S I ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION 16\ ft PROPERTY LINE /01 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 />IVIIIYIIVIV/VI YO I Vrt /IYJrLV I IV/YJ - vL-LPYa7L Vl1LL LVJ JJJ-/ VJ/ <br />SIGNED TITLEI_ej A_ /\ 4G o.f- DATE <br />EPARTMENT ONLY <br />Application Accepted By Date 7i Area Employee ID#��/, tY� <br />Final Inspection By Datej\ ( 1-.,0 Z\ ❑ SPE IAL OERM,T - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS No 0&-) SjT� rtf <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />aaa <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />