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 209 953-7697 FOR INSPECTIONS EXP <br /> I <br /> RES 1 YEAR FROM DATEISSUED <br /> JOB ADDRESS ff 41ddd151z4PCC 1412. CITY/ZIP <br /> CROSS STREET Nl�t APN PARCEL SIZE a <br /> OWNER NAME PHONBG� �_l�+ <br /> OWNER ADDRESS?o ria r, �//2 i/O CITY/STATEIZIP <br /> � W�Bl2 <br /> CONTRACTOR ,- 7/ A To/?Pf-(A/C• PHONE � <br /> CONTRACTOR ADDRESS ?O ��ox 3 !1-7 CITY/STATE/ZIPS <br /> LICENSE ❑ C-42 L] CJ6 OTHER LI NUMBER��I' E%PIRATIONDATE A- ,3/ Z, <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: .44-RESIDENCE ❑ COMMERCIAL Li OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 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 it FOUNDATION ft PROPERTY LINE fl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION fl PROPERTY LINE It <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 CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE C DATE L? <br /> TAYMENT <br /> ticEIVE® <br /> 13 2023 <br /> SAN I QUIN COUNTY <br /> ONMENTAL <br /> iii DEPARTMENT <br /> 1-4 <br /> DEPAARTME — ONLY v A <br /> Application Accept By 6 Date_ ��^ area LA ,q Employee ID# A <br /> Final Inspection By Date L� � ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to e h of 3 Ft: PiVSump Soil Chir/a,,tgr: <br /> COMMENTS AD DP%-0 5F-0— I(L UI)t3 '7 <br /> PE Sc Received Check# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO s Remitted, Service Request# <br /> J t b gl►3\Z3 uQQXDB'}�86 <br /> 42-01 �/_ g O ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 •••���/// <br />