Laserfiche WebLink
7 <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 J CALL 09 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS / CITY/ZIP / -seC;Z O'A , <br />CROSS STREET/ APN PARCEL SIZE <br />A., [�G`Qz <br />OWNER NAME ��� /�// ��n �1`/%�L.y � PHONE <br />OWNER ADDRESS '2 4( <br />%� / �'L t: CITY/STATE/ZIP �.� '�C LC /A 11 <br />CONTRACTOR `/ �� S PHONE <br />CONTRACTOR ADDRE,S �.s"/ CITY/STATE/ZIP � �n 4-1 In <br />LICENSE V-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT #;3P 2- 0 Y LAND USE APPLICATION # <br />TYPE OF WORK: ( NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT I OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE jA COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: (a <br />III SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />❑ LIFT STATION SIZE TYPE OF PUMP <br />/ r <br />CAPACITY �f✓ D gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE _ft <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />� <br />12/ LEACH LINES <br />1 LEACHING CHAMBERS <br />Received <br />By <br />Check# <br />--CVs-h <br /># OF LINES <br />1 <br />LENGTH OF LINES - ft <br />Permit ID# <br />DISTANCE TO NEAREST <br />WELL <br />2.�°� <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />SUMPS <br />WIDTH /ft <br />LENGTH <br />1-2 ft <br />DEPTH �%� ft <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE 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 />SIGNEDTITLE //I/- n« t� � /� DATE �' - / � � Z <br />AA <br />.vr <br />0 22 <br />N1Y <br />PR <br />NT <br />DEPARTMENT USE ONLY <br />Application Accepted Date Z Area ` Employee ID# A . G . <br />Final Inspection By Date 1.-+ b2.-� SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS USP fMSN 00Q_(� C�P.0 F� n S • �., S1J �• L• (A -P <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check# <br />--CVs-h <br />Amount Date Permit/ <br />Remitted Service Request # <br />Invoice # <br />Permit ID# <br />�{ 21(0 <br />2.�°� <br />�-- <br />� <br />7 U • l • 2 �� � SS`I <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />