Laserfiche WebLink
y <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 /> JOBADORESS 304117 SOL(7Jl KOS� If <br /> -KA CITY/ZIP IAr:/f %S-��1- <br /> CROSS STREETDJC APIN PARCEL SIZE /.5-1 <br /> OWNERNAME <br /> PHONE C;?L - <br /> I ./ n a <br /> OWNERADDRESS/� 30(vy7 SaNT-N Ko5T�/2 CITY/STATEIZIP ! // C�4 9S3o4 <br /> CONTRACTOR N r=S f.l Cott U L ll PHONE -999 <br /> CONTRACTOR ADDRESS --- n•a.54 377 1�- CITY/STATEIZIP /U <br /> { ' RL <br /> El -4 <br /> 1J �L �,1�PiI <br /> LICENSE -C2 LlX <br /> C-36 OTHER //`�G NUMBERZ!!�AnEXPIRATION DATE 67 <br /> W TER TABLE DEPT N: iv�/ 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: C RESIDENCE C COMMERCIAL C 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 #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #of LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <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 THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> Mi <br /> 'WADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953 697 <br /> 1 LM 48 H6U <br /> SIGNED TITLE �l✓/L E7�lly/i✓E DATE o'L 2 <br /> T <br /> J 1 <br /> h �f C <br /> TF <br /> EPA RTM IENT NL / ,FkT <br /> Application Accepted B Date Area'J Employee ID-4�� <br /> Final Inspection By Date ❑ SP IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS I j ')^i`� f <br /> PE 3C Received Check#/ Amount Permit/ <br /> Code INFO B Emitted Date Service R uest# Invoice# Permit ID# <br /> S 22 S I;�- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />