Laserfiche WebLink
G) -' <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 <br />JOB ADDRESS (362 - Live - <br />CROSS STREET l�aL�Nz� <br />OWNER NAME <br />OWNER ADDRESS <br />`4.73 -/GJ/ FOR INSPEGIIUNS CXI1IKt5 I T tAK FKUNI UAI t IAJUC1 <br />CITY/ZIP `i $ —(2- <br />APN V �1(J� �S PARCEL SIZE <br />PHONE �— `11b-- 5 - 6&'1b <br />CITY/STATE/ZIP "0 +- l C1'�t `f 5.-112 <br />CONTRACTOR IL 1' (U wtn y`�j PHONE <br />CONTRACTOR ADDRESS Po FSC C` { 2 3! I CITY/STATE/ZIP x-r.rk ��C, 6 - <br />LICENSE ❑C'C-42 '�� C-36 OTHER NUMBER ` 93 P,`1q EXPIRATION DATE <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />s <br />❑ PERC TEST # BUILDING PERMIT LAND USE APPLICATION # <br />TYPE OF WORK: <br />;W <br />REPAIR/ADDITION <br />I- ENGINEER DESIGNED /ALTERNATIVE <br />i.I REPLACEMENT 1 1 <br />OUT -0F -SERVICE SEPTIC <br />SYSTEM <br />I DESTRUCTION <br />INSTALLATION <br />WILL <br />SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />OTHER O O Q <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />}C <br />❑ <br />SEPTIC TANK <br />TYPE/MFG V x('S g <br />CAPACITY <br />981 # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />V <br />LIFT STATION <br />SIZE 24 1 TYPE OF PUMP ❑ PKG TX PLANT <br />❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />E LEACHING CHAMBERS ,�S�i�al <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINED ft <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE VEr, ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH <br />ft <br />DEPTH AjjQ 12 ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />9 X0 <br />ft PROPEF&ALINE ft <br />NJ <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPTH PAII AQUIN ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPE �I0 MENTAI ft <br />��_rWW <br />L3 <br />DISPOSAL PONDS <br />WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ftt FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SEEPAGE PITS <br />NUMBER WID7tHi/" <br />JT7/2�j <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FO DATION <br />ft PROPERTY LINE ft <br />1 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 />DEPARTMENT USE. ONLY �j�j ez:- J <br />Application Accepted B Date �-Z Area Employee ID#{ <br />Final Inspection By Date L2— ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to epth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS G[� . C7t,�r• -- ,w q/'��� Cawrcr�r-,+, ��. ��,;.� _s1r r�L. _ .1'7�5e.. <br />PE <br />Code <br />SC <br />INFO <br />ReceivedChec <br />By <br />s <br />Amount <br />emitted <br />Permit/ <br />ate Service Request # <br />Invoice # <br />Permit ID# <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />T <br />