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 '' ff CALL ZUV JySJi10.91 FOR INSPECTIONS r LXPIRE5 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS W 1201 L i ��l i. CITY/ZIP 1 VaLA C <br />CROSS STREET mni 1 L(^� f� t C �— APN Z / L4 C)'-7 PARCEL SIZE <br />OWNER NAME �'(Ckv l nj'A <br />OWNER ADDRESS <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />LICENSE _J C-42 1, C-36 OTHER <br />�PHONE '2 Z5 �Sg(i—� l I <br />CITY/STATE/ZIP t ywHO� \w C"j\ 1L( St4 Z_ <br />PHONE U <br />CITY/STATE/ZIP <br />NUMBER EXPIRATION DA <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION C ENGINEER DESIGNED/ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM >L_ DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL EI OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />CAPACITY gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATQ <br />ft <br />❑ LEES LEACHING CHAMBERS # OF LINES LENGTH F _ ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROI TjYO <br />❑ ft <br />��� WIDTH ft LENGTH ft DEPTH �'�� ft <br />�ISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />L3MOUN7,�6�/IDTH ft LENGTH ft DEPTH ` ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br />ri <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE r"y"1 ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH SAND ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT VIRp tr Ca1� ft <br />❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH DEPA!'iTu, "-_ It <br />DIS AAE TO NEAREST ELL ft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I H E PREPARED THIS APP ]CATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LA AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM HOUR ADVANCt TICE R UIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 y <br />SIGNED / G �' TITLEy :r.i ,� DATE —/ <br />T <br />DEPARTMENT US ONLY r� <br />Application Accepted By Date Z Area f`� Employee ID# Tyt! t(Uku"L <br />Final Inspection By Date ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS 0 F- 7V-4,t_c_-M,riS <br />PE <br />Code <br />SC <br />INFO <br />Received (CheckAmount <br />B ash <br />Remitted <br />Date <br />PermiU <br />Service Request #PIM <br />A4 rmit ID# <br />wz� <br />0-1-5 <br />,3 <br />1 w cv <br />zl <br />C j -Lf <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/24/12 <br />