Laserfiche WebLink
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 GALL (ZU.9) y53 -/6y/ FOR INSPECTIONS CXPIRLb I TtAK t-KUM L)AI t IbbIJtl <br />JOB ADDRESS 92 C TY'gIP <br />CROSS STREET fiG[L7'D/I/ y_ APN ���/ "" ( PARCEL SIZE v <br />OWNER NAME LA-.)Alyzv-�F�IA,^ A I PHONE SLOG - �5 Lf <br />OWNER ADDRESS / / 6 /91,Vb CITY/STATE/ZIP <br />CONTRACTORi��/7j� (�XG PHONE1�O� <br />" <br />l �J J <br />CONTRACTOR ADDRESS /��y f /A/�% �L�ii CITY/STATE/ZIP =r2t2 ch-�,,%4/ ,4' i <br />LICENSE ZEIC-42 ❑❑C-36 OTHER 1q, NUMBER. 50 -2�0-9. EXPIRATION DATE �� �� 7,-7 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # AND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM CI 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 />El GREASE TRAP 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 ❑ STAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />)lA, LEACH LINES ❑ LEACHING CHAMBERS # OF LINES / I LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION 47 ft PROPERTY LINE ft <br />❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br />c <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft /F/O�UNDATION ft PROPERTY INE ft <br />❑ SEEPAGE PITS NUMBER WIDTH > / i/ ft DEPTH !�-7 ft <br />DISTANCE TO NEAREST WELL_Z ft FOUNDATION //j �' ft PROPERTY LINE S 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 UM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 h <br />SIGNED Z TITLE DATE <br />IF <br />— — — — — — — — — — — — — — t — — — — — — — — <br />E IN <br />I'1 N L <br />� N <br />DEPARTMENT USE ONLY <br />Application Accepted By Date Area l Employee ID# l/( <br />Final Inspection By fLCc� Date _ ❑ SPECT L PERMIT -Approved by <br />Character of Soil to D�ptho^f Ft: Pit/Sump Soil tkracter:COMMENTS � e � 9� <br />PE SCReceived Che Amount Date Permit/ Invoice # Permit ID# <br />Code INFO By ash Remitted Service Request # <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />42-01 <br />4/14/18 <br />T <br />