Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE-PERMIT CALL 209 953-7697 FOR INSPECTIONS . E�XPIRES 1YEAR FROM DATE ISSUED <br /> JOB ADDRESS ZS 1 Z� �L/tt��AYE A� CITY/ZIP ep <br /> -71 y�'LPO /C�ZC� <br /> �1 H <br /> CROSS STREET GO L.L1 t2 APN 0 Z 1—030—3 /lPAtRCECLSIZ�E-qT{�'��q�L• <br /> OWNER NAME �LG—V LNG—EL > C���} <br /> (� <br /> r� PHONE 'yam �^ <br /> OWNER ADDRESS �'� 6z�,� I3�^(0 CRG3- <br /> Y/STATE/ZIP <br /> A 't 3(p <br /> CONTRACTOR ON,(— &67VE"V(l2-0r1jMC1V IAL- PHONE 3�`1`03-1 S- <br /> /1 <br /> CONTRACTOR ADDRESS 140-1 c-J• oAy-- �-T• LO7� Crl TSZ�o <br /> CLCITY/STATE/ZIP e� -7 <br /> LICENSE ❑i.�C-42 ❑OC-36 OTHER `L NUMBER Z1 ( EXPIRATION DATE -i JU"ZZ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> IAC PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I I NEW INSTALLATION ❑ REPAIR/ADDITION I] ENGINEER DESIGNED/ALTERNATIVE <br /> I..I REPLACEMENT i.] OUT-OF-SERVICE SEPTIC SYSTEM i I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ^� <br /> 13A❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES /Y�. <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �I Vi y <br /> Ll FILTER BED WIDTH ft LENGTH ft DEPTH �d <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH /ft AC/ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 'UAQ <br /> N COUNTY <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH H E^I--nr <br /> DISTANCE TO NEAREST ELL ft FOUNDATION ft PROPERTY LINE o1R-rWNT <br /> El DISPOSAL PONDS W <br /> WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 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 /> MINIMUM 4&HQUR ADV CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNEDTITLE t9R-UJ . ✓11 Crf2- <br /> • DATE ( '� _ZZ <br /> ,D PA RTMEN V US 8 ONLY <br /> Application Accepted B Date d Area 'L Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Che Amount Permit/ <br /> Code INFO B emitted Date Service Request# Invoice# Permit ID# <br /> 'L L 54 o9vb9:2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />