Laserfiche WebLink
r <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 F OM DATE ISSUED <br /> JOB ADDRESS 14 A 0 1- CITY/ZIP D ek _f <br /> CROSS STREET C/ C, / O e e /f APN C/U ! — v ( �0� 3 PARCEL SIZE w- <br /> OWNER NAME Yl e h � !/� saA PHONE <br /> OWNER ADDRESS ( G( CITY/STATE/ZIP <br /> CONTRACTOR 1 /� ` -5 WA <br /> S�e 4/41 \ 7 <br /> ! C JV �1 J'/l/ PHONE D 1 <br /> CONTRACTOR ADDRESS �O ,2// 7 f� CITY/STATE/ZIP to Al e �f (////', � <br /> LICENSE JC-42 Ell;Ell;iC-36 OTHER NUMBER P 5 / EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION J r iK REPAIR/ADDITION I /ENGINEER DESIGNED/ALTERNATIVE <br /> Y/ REPLACEMENT !�7 OUT-OF-SERVICE SEPTIC SYSTEM 1✓ DESTRUCTION <br /> INSTALLATION WILL SERVE: IA/RESIDENCE I I COMMERCIAL I I OTHER <br /> NUMBER OF LIVING UNITS: �NUMBER OF BEDROOMS: 1 -'3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG Id 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 TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 1 J <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES Z C 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 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 /> 1 SEEPAGE PITS NUMBER WIDTH!/ r ft DEPTH Z� ft <br /> r DISTANCE TO NEAREST WELL�DO ft FOUNDATION rZ S ft PROPERTY LINE �O ft <br /> 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 48 H UR DV NCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> r- <br /> SIGNED TITLE DATE <br /> DEPARTMENT USE ONLY <br /> Application Accepte By Date Area Employee ID# <br /> Final Inspection By Date kl2 ❑ SP CIAL PERMIT-Approved by <br /> Character of Soil t Depth of 3 Ft: FAVSUmp Soil haract r: <br /> COMMENTS ItruJ <br /> LL 6" <br /> Llk�� r . <br /> PE SC Received Check#/ ount Date Permit/ Invoice# Permit ID# <br /> Code INFO B C sh Remitted Service Request# <br /> 62 <br /> 1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />