Laserfiche WebLink
Sca -1 w <br /> � q� Scat, '4611-1�� <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe AE)DRESS : I � CITY/ZIP (-14)--'—? Lt-0 f�' A <br /> CROSS STREET A r_M " ",.i APN 02 U I PARCEL SIZE L3 ACS p <br /> 4 <br /> OWNER NAME PAU, t` LGA►" rC1^� -QZ ac, PHONE ' ') <br /> OWNER ADDRESS p-I Z I LAO ( rt t P Q L- I C-j__ CITYISTATE/ZIP LC1S A,_m5 gqoZ?- <br /> CONTRACTOR GCS l yy C-,0 PHONE 'S 30._[fir 77 - 17'2. <br /> (/ <br /> CONTRACTOR ADDRESS PO FS�x r-�G CITY/STATE/ZIP FA PAN fes+ 611 q 5-i L, <br /> LICENSE C-42 I ' C-36 OTHER NUMBER , EXPIRATION DATE <br /> C1 <br /> WATER TABLE DEPTH:} ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I.i PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION EPAIRIADDITION ENGINEER DESIGNEE)(ALTERNATIVE <br /> REPLACEMENTOUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION S <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL I_ OTHER 3 <C141 <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 ft FOUNDATION ft PROPERTY LINE ft <br /> LIFT STATION SIZE d 14TYPE OF P P lk PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Ate fi.-._..� <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATpON ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <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 It 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 /> MINIMUM 24 HOJJR ADVANCE NOTICE-REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE 1-7 All <br /> L9 <br /> JO Q <br /> !y CIM Wry <br /> Ar <br /> DEPARTMENT SE ONLY <br /> Application Accepted B4� Date Area Employee ID# <br /> Final Inspection By Date ;71 <br /> l SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS 0,&[l <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> 5 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />