Laserfiche WebLink
It I <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-KEFUNDABL�Ej PERMIT L;ALL LU9) 953-ID91 FOR INSPECTIONS LXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS % / %/ l�%�C/ 1` G%C y CITY/ZIP <br />CROSS STREET `^ 17 L� APN `�ZU - PARCEL SIZE v <br />OWNER NAME /rJll�S7 ^ �C'i1'� y�vw� y 4) PHONE Zj / &"9–��y91zo <br />OWNER ADDRESS /�Q'?�'GA)ay ` ,+ CITY/STATE/ZIP c��QnTe - C -f C),5-336 <br />CONTRACTOR M u des lv �tt •l c� G( �/,�de ( Ae- PHONE <br />CONTRACTOR ADDRESS 6 3 7 7�%a.n.~, G 7 r C�- CITY/STATE/ZIP <br />LICENSE [IC -42 hI C-36 OTHER C r/2 C' Zj NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM i DESTRUCTION .S1ep,'-/c- —fiJ <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />❑ PKG TX PLANT <br />LEACH LINES <br />LEACHING CHAMBERS <br />ft PROPERTY LINE <br />ft <br /># OF LINES <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />DEPTH <br />ft <br />FOUNDATION_ <br />FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />DEPTH <br />ft <br />FOUNDATION <br />MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />SUMPS <br />WIDTH <br />ft <br />LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />DISPOSAL PONDS <br />WIDTH <br />ft <br />LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />ft <br />ft <br />ft <br />ft <br />ft <br />LENGTH OF LINES <br />ft <br />ft PROPERTY LINE <br />ft <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />DEPTH <br />ft <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 />MINIMUM 48 HOUR A,DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED 1'v/ J A a �f�T Fh TITLE DATE <br />DEPARTMENT USE ONLY <br />Application Accepted B Date Area A Employee ID# <br />Final Inspection By Date SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS SV,? 0C s 7'/&0 Sfi:��s S'T S'cHfl- ®F <br />PE <br />Code <br />Sc <br />INFO <br />Received <br />B <br />Cash <br />Amount <br />Remitted <br />Dat <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />!?382- <br />js-2 <br />2 ti <br />0 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />