Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE•STOCKTON CA 95206•(209)468-3420 <br /> NON-REFUNDAfB�+LF PERMIT / CALL <br /> 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> J1 V <br /> Jos ADDRESS 1II'-O�fD' I�..,QS ey'( I )c(.)"c CITAYlzIp �0 <br /> CROSS STREET XfYtV)` U U .ry e{ t�y APN�().,,I�,,/"''.T. 'Y/"J / PARCEL SIZE > <br /> OWNER NAME 01 T 1AAA �� 1& Z4L,&7-. E"'LN_'_I owl PHONE <br /> OWNER ADDRESS +nr'J d da 0-'(//f'V�7"� CITY/STATE21P I /��•S�}r y <br /> CONTRACTOR L'S� W1T1 �l.�tL�--Y\L.7�� PHONE ? � "I/'^l�Q(�4 ,+ <br /> CONTRACTOR ADDRESS _ Up\, CITYISTATEMP� 1 ( A �152-`i Q <br /> LICENSE 01-IC-42 00C•36 OTHER A NUMBER ,5 EXPIRATION DATE 2- ZC', <br /> r�1 <br /> WATER TABLE DEPTH:1101 � t Y O1 ft GEOGRAPHICAL INFORMATION: C nates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 14 RESIDENCE I] COMMERCIAL I_I OTHER <br /> NUMBER OF LIVING UNITS: � NUMBER OF BEDROOMS: 5 NUMBER OF EMPLOYEES: <br /> •r•� <br /> SEPTIC TANK TYPEIMFG t':F L CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG YY CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 1 JO ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> &. LEACH LINES LEACHING CHAMBERS.INf7I M III OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL i t56 ft FOUNDATION IDI�+ R PROPERTY LINE t C> I fi <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ll <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 It PROPERTY LINE ft <br /> O SUMPS WIDTH If 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 -1 WIDTHS 'LTt L R DEPTH L�J 1f <br /> DISTANCE TO NEAREST WELL 150'1' it FOUNDATION i !'f' ft PROPERTY LINE S"♦L fl <br /> 1 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. f <br /> NCE NOTICE REQUIRED FOR INSPECUONS-PLEASE CALL t2O9)953-769 <br /> SIGNED TITLE 'COIG'GT �NX6601U 'eSY' DATE �k I U <br /> E H EN <br /> Y" <br /> Application Accepted By AN. Date I LAre :4E�41 Employee ID# <br /> Final Inspection By Date Z 2 SPECI PERMIT-Approved by . <br /> Character of Soil to Dept6 of 3 Ft: Pft1Sump Soil Character: <br /> COMMENTS <br /> PIr V <br /> P2YV�t2C1 \I11SLC1��1 _ �� Ir <br /> — <br /> Y`�_ <br /> PE SC Received hoc Amount Date Pe-IV <br /> Invoice# Permit ID# <br /> Code INFO B Remitted Service R uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 <br />