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 PERMITCALL 209 953-7697 FOR INSPECTIONS tXPIRES "I YEAR FROM UA1 t ISSUtl <br />1 SM WAS M_ <br />JOB ADDRESS `N }CITYIZIP Q <br />CROSS STREET �N ZV 111 ��+1\�`CnV APN I v PARCEL SIZE <br />1 G' 6 Q <br />OWNER NAME W1\�1C S �^ PHONE&i X150 �I]���� 1 <br />OWNER ADDRESS �,/ (����� C �'n �,� (CITY/STATE/ZIP S IR�Ir-A, -"l o o j N <br />CONTRACTOR I���C (j f 1" wIhbS_1 UVJ k Qr\ S4 Sk & PHONE �(/.U(�22-3� o /+ A �Mf <br />CONTRACTOR ADDRESS � �\� Q� I�I0 L O a CITY/STATE/ZIP . L/ ` / � / • � � <br />LICENSE VC -42 ❑ C Cti36 OTHER <br />NUMBERCAngtog EXPIRATION <br />WATER TABLE DEPTH: 610-30 ft GEOGRAPHICAL INFORMATION: <br />❑ PERC TEST # BUILDING PERMIT # a 10 i 9 <br />TYPE OF WORK: L NEW INSTALLATION , , I REPAIR/ADE <br />Coordinates X Y_ <br />LAND USE APPLICATION # <br />)N _ ENGINEER DESIGNED <br />TERNATIVE <br />x REPLACEMENT lel 11 k ,> t 1 C.[CA r- OUT -OF -SERVICE SEPTIC SYSTEM )( DESTRUCTION ? CN K <br />INSTALLATION WILL SERVE: LY RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: H NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG _PA L CAPACITY L.I 0 0 Q gal # OF COMPARTMENTS -7— <br />EJ <br />❑ GREASE TRAP TYPE/MFG ` CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL L D'1 ft FOUNDATION 7 O l ft PROPERTYLINE 1 ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />�I <br />LEACH LINES <br />- LEACHING CHAMBERS W D I <br />L1210 <br /># OF LINES <br />6 <br />LENGTH OF L• , <br />7 F' o <br />1 <br />_ ft <br />DISTANCE TO NEAREST <br />WELL S 4 ft <br />FOUNDATION -7-0 <br />ft PROPERTYLINE <br />ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />It <br />❑ <br />DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY U.N27, <br />ft <br />❑ <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT 1 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 />DATELI 1- 47- <br />DEPARTMENT USE ONLY <br />Application Accepted By lii% Date I // Area qq Employee ID# <br />Final Inspection By Date 2 6 �, �- ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of Ft: Pit/Sump Soil Character: <br />COMMENTS of c;eob_ per- FP-,,2,ol8,0y SFR -}, be <br />fi <br />IY►11� mol", Lded i�r�I� S -x 7d li>7e5 tO 6, A C0';b r'1/Y7esCie ►/�e/a�_o c <br />`PE SC Received <br />Code INFO B <br />(-Checkq Amount <br />Remitted <br />Permit/ <br />Dae Invoice # Permit ID# <br />Service Request # <br />L1210 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />rn <br />H <br />[27 <br />b <br />tv <br />