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 CA 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ^ I 1 ` . CITY/ZIP <br /> p t� <br /> CROSS STREET t A P N PARCEL SIZE p <br /> OWNER NAME 'l I1� Lam( PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP //j' <br /> CONTRACTOR U / PHONE 20 C / v — OL11 <br /> CONTRACTOR ADDRESS �7(J J. CITY/STATE/ZIP � ly<< <br /> LICENSE 1_1 C-42 ❑FIC-36 OTHER NUMBER ,?02Y/ 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 REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG j!2�q%t f'/�/� 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 /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> \ FILTER BED WIDTH /+b� ft LENGTH 4-0/ ft DEPTH 1--c1 - 1+2� ft <br /> DISTANCE TO NEAREST WELL ( 00 r + ft FOUNDATION �t ft PROPERTY LINE �jlf 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 /> ❑ 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 /> MINIMUM-48,HO,UR,AQVAN TICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DAT /- 2 C'c_C <br /> life -A <br /> P�OAQUIN <br /> VI <br /> H M NT <br /> Ty FN <br /> PARTMENT US ONLY Q� <br /> Application Accepted Date Area l Employee ID# <br /> Final Inspection By Date rpCz 1-1SPECIAL PERMIT -Approved by <br /> Character of Soil to Depth of 3 Pit/Sump Soil Character: <br /> COMMENTSI]f," J OSIVi2Czf'E�(� <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> 4v�� l l �l ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14//14/18 <br />