Laserfiche WebLink
OWN <br />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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 6631 South Jack Tone Road CmIZIP Stockton,95215 u.a <br />CROSS STREET Mariposa Rd. APN 181-080-170 PARCEL SIZE 1.19 Dv <br />OWNER NAME Dennis Faist PHONE(209)639-1581 <br />OWNER ADDRESS 6595 South Jack Tone Road CITY/STATEIZIP Stockton,CA.95215 <br />CONTRACTOR TB.S West PHONE(209)652-7811 <br />CONTRACTOR ADDRESS PO BOX 1592 CrrY/STATE/ZIP Linden,CA.95236 W <br />LICENSE I C-42 C36 OTHER A&B NUMBER 939001 EXPIRATION DATE 10/31/202 1 <br />WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X l• I~v`Y 7. I I I <br />PERC TEST # BUILDING PERI # LAND USE APPLICATION# <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ <br />IAA <br />TERNNATrVE/ <br />REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION 1 <br />INSTALLATION WILL SERVE: RptDENce COMMERCIAL OTNeR <br />NUMBER Of LIVINo UNRS:NUMBER OF BEDROOMS: NUMD[R OF EMPLOYEES <br />0SEPTICTANKTYPEIMFG ! /V C.,/JG CAPACITY -7a d gal #OF COMPARTMENTS_ Y1 <br />GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL R FOUNDATION it PROPERTY LINE it <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br />J <br />LEACH LINES LEACHING CHAMBERS OF LINES I LENGTH OF LINES 3b It <br />DISTANCE TO NEAREST WELL /DrJ it FOUNDATION ft PROPERTY LINE -7A it <br />FILTER BED WIDTH it LENGTH ft DEPTH ft 'JDISTANCEToNEARESTWELLitFOUNDATIONitPROPERTYLINEft <br />MOUNDED WIDTH It LENGTH ft DEPTH it <br />DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH R LENGTH ft DEPTH t <br />DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it <br />DISPOSALPONDS WIDTH ft LENGTH it DEPTH it <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH it <br />DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE it <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 />CI48VANNCIN <br />p/ <br />Z1. <br />L0 3-7 <br />1- <br />SIGNED TITLE !/ (1L ,41111.Qf DATE 1//.tS ZO "1 <br />pqAmYMFcFj NT <br />R FD <br />olj/N c4A17 <br />N <br />DEPARTMENTJUSff ONLY <br />yApplicationAcceptedy! ` Date Z z-d Area r C Employee ID# i/A <br />Final Inspection By Date Z SPECIAL PERMIT-Approved by <br />Character of Soil to eoth of 3 Ft: <br />G Pit/rump SqV Character: <br />CO ENTS :Yl.+r, CD4kIi/O44' rC G tYL C S <br />Alt M Tec,-ea <br />PE SC Received Check#/ Amount <br />Date Permit/ <br />Invoice# Permit ID#Code INFO B ash Remitted Service Re uest# <br />zz ops Isa 22 w 5 20 <br />4/ <br />141 078-09 3 / ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/1B J/ (/lJ(v (/