Laserfiche WebLink
I <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-KEFUNDABLE PERMIT <br />GALL ZU9 <br />953-7697 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUE <br />JOB ADDRESS I3� <br />CROSS$TREET^ <br />LEACH LINES <br />CITY/ZIP <br />APN � <br />PARCEL SIZE IL <br />OWNER NAME 441F /,IIIb d!? PHONE <br />OWNER ADDRESS ! L <br />�- ) o 0 I 1V ; )1/ CITY/STATE/ZIP LID J- i /�j� � /o <br />CONTRACTOR I'L/i I (�]V i" It �� � C/��/�, /fir J PHONE <br />CONTRACTOR ADDRESS �( y�% /')�-t'�/i `i'^- //�•`L�C_ CITY/STATE/ZIP s:` <br />LICENSE ❑ -42 1111C-36 OTHER NUMBER �rlvys EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # d J 3 S U 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 ❑ COMMERCIAL/ ❑ OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: \ 3j NUMBER OF EMPLOYEES: <br />' U <br />❑ <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG l{! /r L <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL ,'60 <br />SIZE TYPE OF PUMP <br />CAPACITY ��� gal # OF COMPARTMENTS .2 <br />CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />❑ LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES / ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />FILTER BED <br />WIDTH ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH ft <br />LENGTH <br />ft <br />DEPTH ft <br />SEEPAGE PITS <br />DISTANCE TO rREST WELL <br />NUMBER <br />WIDTH <br />Jft` <br />`/ <br />FOUNDATION <br />ft <br />ft PROPERTY LINE ft <br />DEPTH p�ft <br />DISTANCE TO NEAREST WELL <br />/Sc <br />ft <br />FOUNDATION <br />ft PROPERTY LINE 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 />Application Accepted By Date Area Ll Z Employee ID# Ff�^►� V <br />Final Inspection By L Date % ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character_: <br />COMMENTS �e('C':' 0 C Erb % ,er 7 '� 7 -f Z (., I ��� <br />PE SC Received CLC / Amount Dat Permit/ Invoice # Permit ID# <br />Code INFO B Cash Remitted Se ice equest # <br />q a 1 I P-7 f's ?&I ' yp <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />