Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOADUIN COUNTY FwRoNMENTAL HEALTH DEPARTMENT 1868 E. HAZELToN AVENUE- STOCKTON CA 95206-(209)468-3420 <br />NON-REFUNDABLE PERMIT <br />CALL (2M 953-7697FOA INSPECTIONS <br />EXPIRES 1 YEAR FROM HATE ISSUED <br />JDB ADDRESS Z S . <br />11 V S 7 />\1 I7�-iJ . <br />crtyma <br />CROSS STREET V,) t ST 9-1 PG <br />ApN 2 -ZS- " � G'O <br />PARCEL SIZE 2. -1 A -C. . <br />OWNER NAME Sg J ,-J 3 H7AJ <br />`T I j C 12 C) <br />a REPLACEMENT ci <br />PHONE � � iT� � � q <br />OWNER ADDRESS VAiN`I <br />SERVE: 0 RESIDENCE <br />CITY)STATElCiP <br />C OTHER <br />CONTRACTOR -� � �'% <br />A,1 V � N V+" I <br />A.•1 i PI,.... PHONE 7, f) <br />CONTRACTOR ADDRESS <br />w. o AY— Sr. <br />CITYiSTATIYJP <br />L-�o t) t C^ q S7 • -'f 0 <br />LICENSE 111"IC42 00c*6 OTHER <br />C^y <br />cP'� NUMBER �"� a i EXPIRATION DATE <br />It DEPTH <br />WATER TABLE DEPTH. <br />ft GEOGRAPHICAL INFDRMATm,. ComdInat" X Y <br />(!� PERC TEST tlI <br />BUILDING PERMIT # <br />ft <br />LAND USE APPLICATION Jl <br />TYPE OF WORK: <br />0 NEW INSTALLATION h <br />REPZ7A5DrTION <br />D ENGINEER DESiGNED)ALTERNATIVE <br />ft <br />a REPLACEMENT ci <br />OUT -OF -SERVICE SEPTIC SYSTEM a DESTRUCTION <br />INSTALLATION WILL <br />SERVE: 0 RESIDENCE <br />C COMMERCIAL <br />C OTHER <br />NUMBER of Lfvm UNITS: NUMBER OF BEAROo4LS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPENFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />T YPEIMPG <br />CAPACITY <br />gal # Or COMPARTMENTS <br />It DEPTH <br />DISTANCETO NEAREST: WELL <br />ft FOUNDATION <br />_ It PROPERTY LINE ft <br />CI LIFT STATION <br />Sin _ TYPE OF PUMP <br />0 PKG TX PLANT <br />U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES O LEACHING CHAMBERS <br /># of LINES <br />LENGTH OF LINES <br />ft <br />DIBTANCE To NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />FILTER BED WROTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDAMON <br />It PROPERTY LINE <br />It <br />❑ <br />MOUNDED WcTw It LENGTH <br />It DEPTH <br />ft <br />DISTANCE To NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE <br />R <br />❑ <br />SUMPS WoTH It LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />DISPOSAL PONDS WwTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE To NEAHEBT VELI. <br />ft FOUNDATION <br />It PROPERTY LINE <br />ft <br />❑ <br />SEEPAGE PITS ULOWER WIDTH <br />It DEPTH <br />ft <br />thsTANOE To NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />CERTIFY THAT i HAVE PREPARED TM APPLICATION AND THE WORK WILL SE DONE IN ACCORDANCE WITH SAN JOAOUON COUNTY ORDINANCES.. <br />I HEREBY <br />STATE LAWS AND RULES AND REGULATIONS of SAN JOAQUIN COUNTY, <br />TL'DI E G YX C_, <br />. DATE <br />DEPARTMENT, <br />Application Accepted By L ' Lam- Dem 1 11 Area S � Employ ID# <br />Final inspection By Dam 0 SPECIAL PERMIT - AppIV-d by <br />Charaeter of Soli to Depth of Ft: PiVSump Soil Character: <br />COMMENTS ," 6f PUM11 <br />42-41-7 /'y t ONSITE WASTEWATER TRTMND SYSTEM PER1AlT <br />1Y <br />