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 PERMIT ,} `CALL 20�9,/ 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS (9 int . (��U 1 it ''ta . CITY/ZIP TraCU , 953 CIL/ <br /> CROSS STREET MCA L /I I l/ Al APN )-51-020- 1(0 PARCEL SIZE D?• O l 0 <br /> OWNER NAME V a/n K.(m d 1 u d e S PHONE �Q <br /> p p <br /> OWNER ADDRESSYC� OSCh U p fp) CITY/STATE/ZIP �cAS 3 <br /> E' ? y. Ni11 rVSVC }1 `CONTRACTOR <br /> � n ' II <br /> CONTRACTOR ADDRESS P. 06 k 110 MOpIu CITY/STATE/ZIP / <br /> (� <br /> .n <br /> f S J <br /> LICENSE Ell-IC-42 ❑.IC-36 OTHER & -'$ A NUMBER �a I b�EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: j NEW INSTALLATION X REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: :3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> p LIFT STATION SIZE I NP TYPE OF PUMP ProEl0 ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> P�13 Ill� <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE ft <br /> SUMPS WIDTH ft LENGTH 11 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 /> MINIMM jfi HOU DV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-769�y7 1 <br /> SIGNED v ✓�- TITLE � ��� DATE —� "1 —X 12-2. <br /> ev <br /> v+' <br /> .7 1211 <br /> Q rN <br /> H � T <br /> / <br /> DEPARTMENTUSE ONLY FNT <br /> Application Accepted By — Z Date a01,/,2 ZI Area S �G Employee ID# As <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: OiUSu p oil Character: <br /> COMMENTS Acldl k0l .ala of hfi S)vJian S d!c S 4em• <br /> 5 F P VJnlvey, issue r I c 4e,1141 01r 1� BC}(bn r0>v+ S e,12 t r c '� r7'e,-✓ S 16,C, L fe_ <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> '4,4a-0 4 Iia T P .21 U,Dogs 99q <br /> 42-01 C, ( �OI I/ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 "C <br />