Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 1� >/ <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />OrMi2aa111LI1111:311:111J:1:iifill <br />JOB ADDRESS <br />CROSS STREET <br />GALL <br />OWNER NAME r)?'6�Cleo j T \l APG$Tk66 , L.�L <br />953-/69/ FOR INSPECTIONS LXPIRES IYEAR FROMUATE ISSUE] <br />CITY/ZIP '( 1� C145 <br />/ -_�5 -7 77 <br />APN� PARCEL SIZE <br />OWNER ADDRESS <br />��_ o(9)I `�`�l ��\ ����D EQL�� +'r& <br />CONTRACTOR 4 0-f (4'4— V `Y^Q1"4 ��(�MQt�1pITION <br />CONTRACTOR ADDRESS "� 01 <br />LICENSE C-42 nnC-36 OTHER ��'^''r� NUMBE <br />CITY/STAT] <br />O� 4S-7-7 <br />PHONE /L ` (4 - -Z-�-14 Q <br />CITY/STATE/ZIPD�S <br />EXPIRATION DATE I ZO l <br />WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT - OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE LI COMMERCIAL I__ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OFC ARTMENTS <br />DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPEgTY ■11E ft <br />❑ LIFT STATIO SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPA k �ENCL M) <br />.. - _.._.._ _.. _ _.._._�._ ........_---�1,� <br />LJL S ACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br />❑ ♦T�Lfff WIDTH _ ft LENGTH ft DEPTH It <br />)� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _ ft <br />❑ MOUNDED WIDTH It LENGTH ft DEPTH /VP ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ _ ft <br />❑ SUMPS WIDTH ft LENGTH ft DEPTH 20igft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINES 4DA ft <br />El DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH HFALT MEN]e� ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE MENT ft <br />❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />SIGNED %/� _ !/Z/` _ TITLE >�Z��GS r y V�.N '�— DATE ��447 <br />� <br />A R T M E N T US ' ON Y /'� <br />Application Accepted By + Date Area V Employee ID# r ►r <br />Final Inspection By _ Date I SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3, t Pit/Sump Soil Character: <br />COMMENTS <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Cash <br />Amount Date <br />Remitted <br />Permit/ <br />Service Request # <br />I i e # Permit ID# <br />vZ <br />SROo-7 y <br />a.i AX L' ." <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />T <br />