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 PERMIIjT�f" ADU <br />GALL (LUY '90J-16'91 FOR INSPECTIONS <br />LXPIRES I T EAR FROM UA I E 155UE <br />JOB ADDRESS �-�/j' tV2 / 3) 7 �8 j <br />P, V - I I r-� <br />CITY/ZIP <br />❑ LEACHING CHAMBERS <br />� <br />LENGTH OF LINES ft <br />JLj i <br />`I <br />31 <br />CROSS STREET /�/��.X <br />APIN <br />I I <br />PARCEL SIZE . <br />OWNER NAME s 'C.s <br />WIDTH aln ft LENGTH <br />3C7 ' <br />PHONE 1,V1,V9'y <br />OWNER ADDRESS1-7700 K,eN/VI I S 0 n <br />CITY/STATE/ZIP <br />LAcj <br />CONTRACTOR /_/r_Lf�/1G/�/�.�,���u <br />/ <br />/��yGy�- <br />/ <br />PHONE <br />// <br />CONTRACTOR ADDRESS���1i./��•� <br />/rte'/� f,� <br />CITY/STATE/ZIP <br />LICENSE ❑M-42 11CIC-36 OTHER <br />NUMBER S_%6�S EXPIRATION DATE Os7c2 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT #_Fj9 LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION I ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT L' L -, F ( 'U'' h� ❑ OUT -OF -SERVICE SEPTIC SYSTEM X DESTRUCTION SV j IL- f1f,11 � <br />INSTALLATION WILL SERVE: RESIDENCE ' ❑ COMMERCIAL 3 6M1 ,I yl ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: f A NUMBER OF EMPLOYEES: <br />❑ <br />❑ <br />13 <br />❑ <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG , i <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />- <br />CAPACITY 7�YiG gal # OF COMPARTMENTS -Z- <br />CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />❑ LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />gd10 <br />js <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />FILTER BED <br />WIDTH aln ft LENGTH <br />3C7 ' <br />ft DEPTH yV ft <br />DISTANCE TO NEAREST WELL i f ea' <br />ft FOUNDATION /U' <br />ft PROPERTY LINE %t> i'' ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />tk <br />SEEPAGE PITS <br />NUMBER aS WIDTH ;.Al11 <br />ft DEPTH �S ft <br />DISTANCE TO NEAREST WELL A10 -''ye <br />ft FOUNDATION /U <br />ft PROPERTY LINE /D 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 />DATE Z <br />T <br />DEPARTMENTUSE ONLY <br />Application Accepted -��� 1 Date 5 �! a Area �'/ a0�a Employee ID# F <br />Final Inspection By Dater % SPECIAL PERMIT -Approved by CIC <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Ncl,"fepetr - Tier �• SE(Z bedlacms v-nd Gt/ ><G-hP <br />9P aa006%o3 to(3 6echb,)M5- QS �nnroieol by Ffn�Y!-�YYI �;coo-fdf ne-- r� )' e) -y) IRI da ��Z) , r, i) IF �Iltd <br />bbslt�. No perrv,I}s C -Ce r: Arte �1Ih�6c s i-iC ;cb ;\'► <br />Vj <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 />gd10 <br />js <br />E <br />43oo <br />P, 00�s )H <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />