Laserfiche WebLink
CONTRACTOR ADDRESS Gcvc q <br />CITY/STATE/ZIP <br /> den40-- CA 95-3 /6, <br />LICENSE E1C-42 00C-36 OTHER <br /> NUMBER e273 CA? EXPIRATION DATE <br />JOB ADDRESS 2.-2- 530 6 1-P1 <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />S1rt..4 <br />CITY/ZIP <br />APN RSOOTO) <br />114 <br />PARCEL SIZE 4 30 <br />PHONE L192.- c,iog <br />CITY/STATE/ZIP <br />PHONE g,09 <br /> <br />C; 5 Ce 392— <br />Loi- <br />rt) <br />0 PERC TEST # <br />TYPE OF WORK: EJ NEW INSTALLATION <br />Al REPLACEMENT 34 el <br />trl REPAIR/ADDITION <br />Li OUT-OF-SERVICE SEPTIC SYSTEM <br />n ENGINEER DESIGNED /AiLTERNATIVE <br />DESTRUCTION 4 vIK <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />Application Accepted B <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS ..Se)6cic k .ft) v,te 1 Is <br />Coo+ se+10Ack dirty vsieli <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 />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X :ssalluay 311S <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br /> E COMMERCIAL <br /> D OTHER <br /> <br />NUMBER OF LIVING UNITS: <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />iy <br />CAPACITY I 2-5 0 gal # OF COMPARTMENTS <br /> 7, <br />CAPACITY gal # OF COMPARTMENTS <br />/0 50+ ft FOUNDATION ft PROPERTY LINE i° ft <br />TYPE OF PUMP <br /> PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />ca SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE <br />Sriyck '- <br />DISPOSAL PONDS WIDTH ft LENGTH <br />LENGTH OF LINES ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft <br />ft DEPTH ft <br />FILTER BED WIDTH ft LENGTH <br />MOUNDED WIDTH ft LENGTH <br />SUMPS WIDTH ft LENGTH <br />LEACH LINES E LEACHING CHAMBERS # OF LINES <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH <br /> ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br /> ft PROPERTY LINE <br /> 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 />MINI UM 487R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE Prent DATE 743/ <br />PAY11 <br />RECEN D <br />,A 0 2 22 ( cyl <br />SAN JOAQUIN uuuNTY <br />TAL <br />HEALTH DEPFATMENT <br />ENV-RONN EN <br />DEPARTMENT U E ONLY <br /> Date aia Area s/q Employee ID# A s <br />Date t,q 1 /t .2_, 0 SPECIAL PERMIT -Approved by <br />Pit/Sump Soil Character: <br />0 pe 1P1 J-S ror plOpV147 "'fpcif17/ Me. ti <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted Date <br />Permit/ <br />Service Request p_ Invoice # Permit ID# <br />10 ° Ci 11 5- IV IA' 2 `300 2-11-1- g-iQ-00 De If- <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18