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-KEFUNDABLEPERMIT q L;ALL ZUy ybJ-1 b.91 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE <br />JOB ADDRESS � /1qq �y !� ! F ) TTI N U e CITY/ZIP C ��+ `'/ 5 Z) / <br />CROSS STREET T -S �� lJ lC% j APN /o/ J PARCEL SIZE D t <br />OWNER NAME �/ / �J PHONE a /� <br />OWNER ADDRESS Q &h4 k l� CITY/STATE/ZIP <br />CONTRACTOR l v PHONE <br />CONTRACTOR ADDRESS / r� Pv/ CITY/STATE/ZIP <br />LICENSE (�C-42 ❑OC -36 OTHER NUMBER W 5/10V�5 EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />E PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: J NEW INSTALLATION REPAIR/ADDITION Ll ENGINEER DESIGNED /ALTERNATIVE <br />IL REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM Li DESTRUCTION <br />INSTALLATION WILL SERVE: /RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: L' NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />7 <br />❑ SEPTIC TANK <br />TYPE/MFG Stivl <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG s <br />CAPACITY <br />gal # OF COMPARTMENTS <br />( ' <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <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 />Character of Soil to <br />COMMENTS <br />PE SC Received <br />Code INFO By <br />LEACH LINES <br />- LEACHING CHAMBERS <br />Permit ID# <br />c-) <br /># of LINES <br />LENGTH OF LINES 7,9 <br />ft <br />( ' <br />DISTANCE TO NEAREST <br />WELL <br />r <br />ft <br />FOUNDATION <br />ft PROPERTY LINE �O I <br />ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />SUMPS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />SEEPAGE PITS <br />NUMBER <br />WIDTH �� <br />/ ft <br />DEPTH �S ` <br />ft <br />( <br />DISTANCE TO NEAREST <br />WELLS ft <br />FOUNDATION 3o ' <br />// <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 />Character of Soil to <br />COMMENTS <br />PE SC Received <br />Code INFO By <br />Check#/ <br />h <br />Amount Date Permit/Invoice # <br />Remitted Service Request # <br />Permit ID# <br />c-) <br />�o Ae�,ti15 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />