Laserfiche WebLink
JOB ADDRESS #17 St/ n se+ red_ 3°.'s%50i., crryizip -77-6.4e1 qs--.?oy <br />CROSS STREE1 _ /45.5 C'IN-) /a-IL APN ?0 d 08'0)7 PARCEL SIZE <br />OWNER NAME 237.e40,A1 /2/ ;1/ 0,e,#) PHONE Z40- Er 3z- 332fri <br />OWNER ADDRESS 300D0 - 1 0 )4,..ssor , Pc/ CITY/STATE/ZIP Trify 9s-3o ,/ <br />CONTRACTOR _Z-J7410/ .1"..Ve" <br /> PHONE 76fr- ce)z7 <br />CONTRACTOR ADDRESS <br /> CITY/STATE/ZIP <br />LICENSE Elgt-42 :DC-36 OTHER NUMBER 9.5769S—EXPIRATION DATE 0 <br />5 .77;ak. <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 CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />WATER TABLE DEPTH: <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: 0 NEW INSTALLATION <br />REPLACEMENT <br /> hort.)i 0 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION fel k. <br />0 REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE <br />INSTALLATION WILL SERVE: RESIDENCE LI COMMERCIAL pi, <br />4-f 4 Li-0 1- <br />NUMBER OF BEDROOMS: 3 <br />C OTHER <br /> <br />NUMBER OF LIVING UNITS: <br /> <br />NUMBER OF EMPLOYEES: <br /> <br />SEPTIC TANK TYPE/MFG "ePZ <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL 9/29 <br />CAPACITY AZO gal # OF COMPARTMENTS 6,2 <br />CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION JO / ft PROPERTY LINE <br /> <br />ft <br />LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT 1:1 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES ri 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 />CI MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH 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 />MINI UM 48 H :"VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE../..1.0,16.e.i.c DATE <br />41 N <br />Application Accepted By <br />Final Inspection By 79. S 3Y 6' <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS ncietetmi n 1.)er <br />0 <br />t9 46(.' <br />r)L <br />SAN <br />Date 10/ Vitt 0 SPECIAL PERMIT -Approved by <br />Pit/Sump Soil Character: <br />Et -Crptie /rink repiatemerri- o;-+ <br />sADAQuhv ENV/fir , CotiNry <br />111AL-r4 DTANTAL <br />DEPARTMENT USE ONLY ME <br />Date it1/3Th Area -/qq Employee ID# <br />p,1.1).3 1.4 <br />)2.• y <br />0 PANE <br />R EcEivED <br />uCT n 3 2022 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />theck*-'- <br />Cash <br />Amount <br />Remitted lipate Permit/ Invoice # Permit ID# <br />LP Oci il S- 0/(7771 2q1Nio f-siD- 10151)-i <br />Service Remiest4 <br />Sr0Ogv/g <br />42-01 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18