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-KEFUNDAB�LE FERRMIIT GALL ((LUy)y53-/0Vt FOR INSPECTIONS n n CXPIKES 'I TEAK FROM UAI t 156ULI <br />JOB ADDRESS �rJ-1 b '� 1 %� �O��CS�Ti^ � )L� -CITY/ZIP <br />K'1 id) ICA <br />CROSS STREET — �e I 1 d Axe APN p 1 � I � d � / PARCEL SIZE 10 <br />11,4!p <br />1 <br />OWNER NAME 5C,, v1 11,4! p/� G U t i e.rf e Z PHONE <br />OWNER ADDRESS ,�►6/�� Ch)CkAsa✓" C/" CITY/STATE/ZIP pInI,nf�eyL� (`,�J5336 <br />CONTRACTOR I ► t��� L'5G� k01t_ t - PHONE � C( I ,A^-{iJ (r _ �bG s <br />CONTRACTOR ADDRESS P�/C 60 d CITY/STATE/ZIP ✓I' `.4A4ce z/ <br />LICENSE ❑1'C-42 0I'C-36 OTHER NUMBER ? EXPIRATION DATE aaa�1 l� <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # d j 0 saa ) LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION I_i REPAIR/ADDITION C ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION <br />INSTALLATION WILL SERVE: L116ESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: -J NUMBER OF EMPLOYEES: <br />4- SEPTIC TANK <br />TYPE/MFG /' l -L <br />CAPACITY ./ m gal # OF COMPARTMENTS v� <br />Check#/ <br />Cash <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />Invoice # <br />Permit ID# <br />DISTANCE TO NEAREST: WELL 16 n ft <br />FOUNDATION �6t ft PROPERTY LINE �Q <br />ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />LI LEACHING CHAMBERS <br /># OF LINES -3 LENGTH OF LINES ODI <br />ft <br />DISTANCE TO NEAREST WELL i ft <br />FOUNDATION ao1 ft PROPERTY LINE Ian <br />ft <br />❑ FILTER BED <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft <br />FOUNDATION 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 />t <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED <br />TITLE G671�11►CGf.<<' DATE �- <br />�-y� ) DEPARTMENT U E ONLY <br />Application Accepted Date 8 31 Area s�1� Employee ID# <br />Final Inspection By Date (i SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS IJevJ SF12 4<'--D 14- V*) \-,' <br />PE <br />Code <br />Sc <br />INFO <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />Lail <br />07 <br />6a <br />31 <br />G <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 ( ! 9�/ �v 3,j <br />