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-REFUNDABLE PERMIT <br />GALL "109 953-1691 FOR INSPECTIONS <br />1 YEAR FROM DATE ISSUE/ <br />JOB ADDRESS r <br />3�7� <br />y <br />�_.) w y a 1�Q CITY/ZIP �7 <br />L LEXPIRES <br />yL I� T �� -d js <br />CROSS STREET <br />y-7 <br />I-i� h <br />APN 101 1 5 0O1:9 <br />10115001:9 <br />PARCEL SIZE ' <br />OWNER NAME <br />l LIYL� <br />7 <br />l L l� Y <br />PHONE <br />OWNER ADDRESS <br />CITY/STATE/ZIP <br />/ = Y Irk S <br />CONTRACTOR IM <br />��C Q �S <br />c <br />r' 4GEG(�,r/-L/�� ?-e I- PHONE <br />p <br />CONTRACTOR ADDRESST_� <br />CITY/STATE/ZIP <br />Uy^LC�l7uCs9% 1 Z',4- <br />LICENSE EliC-42 <br />11,C-36 <br />OTHER NUMBER (e EXPIRATIONDATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT# <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT i n k s , h I <br />LAND USE APPLICATION # <br />REPAWADDITION _,ENGINEER DESIGNED /ALTERNATIVE <br />OUT -0F -SERVICE SEPTIC SYSTEM �'� DESTRUCTION u N k <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: y 0� NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG P411— <br />El <br />L❑ GREASE TRAP TYPE/MFG <br />❑ LIFT STATION <br />EACH LINES <br />❑ FILTER BED <br />❑ MOUNDED <br />❑ SUMPS <br />CAPACITY jj 7) gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL I a1Sl ft FOUNDATION3 p� 1 ft PROPERTY LINE ;01 ft <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL I ho' ft <br />ft LENGTH <br /># OF LINES <br />FOUNDATION Ot ft <br />ft <br />WELL ft FOUNDATION <br />ft LENGTH <br />WELL ft FOUNDATION <br />ft LENGTH <br />WELL ft FOUNDATION <br />LENGTH OF LINES 5-S7I ft <br />PROPERTY LINE ft <br />DEPTH <br />ft PROPERTY LINE <br />ft DEPTH <br />ft PROPERTY LINE <br />ft DEPTH <br />ft PROPERTY LINE <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />6Y SEEPAGE PITS NUMBER 3 WIDTH 3(s II ft DEPTH qS-1 t� ft <br />DISTANCE TO NEAREST WELL / �/S / ft FOUNDATION 'rot ft PROPERTY LINE 2 d I 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 />SIGNED <br />Wr[ 11VOrC1- IIVIVO - rLC/iOC (LVVVU.) ;I Oyr <br />TITLE Ci (' C.e—lj-�,j r DATE �- <br />DEPARTMENT USE ONLY / Iy <br />Application Accepted B �— Date n Area �- % Employee ID# Frm A lJ <br />Final Inspection By Date Z `��ZZ— ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Dep h of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS 1`'IP> 11, t�.nC�� C'rmlh �. �.�,�tr>7� 1►hes �0 be 01,60tjorred, <br />PE <br />Code <br />SC <br />INFO <br />Received hec <br />B Cash <br />Amount <br />Remitted <br />D to <br />Permit] <br />ervice Re uest <br />Invoice # <br />Permit ID# <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />7A <br />