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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3 e CITY/ZIP v' <br /> CROSS STREET v <br /> ���-{� E rr �/�IT�� APN .� �l��l� PARCEL S¢E J� <br /> `]1A1,1 f g <br /> OWNER NAME I{Ayl l PHONE <br /> OWNER ADDRESS\'•`I)n(S`C•Im /f�/►C 1LI� / CITY/STATE/LP //�'(/�► <br /> CONTRACTOR 11yl(J t,Lt(sit t�,��c I-r(Di(, i n c- PHONE V /L-601, <br /> 3/�3 ci• 73gq a <br /> CONTRACTOR ADDRESS 33 ! r Iy1 i Y e Y I 97• CITY/STATE/ZIP L- 0'T CA" <br /> LICENSE C-42 C-36 OTHER A NUMBER I I EXPIRATION DATE 202-3 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 1v REPAIR/ADDrnON ENGINEER DESIGNED/ TERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM J( DESTRUCTION L' 4 <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL I-II OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: II NUMBER OF EMPLOYEES: <br /> /01 SEPTIC TANK TYPE/MFG CAPACITY 1(000 gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY f� gal #OF COMPARTMENTS (rte <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION 11) it PROPERTY LINE C-5 ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP <br /> ❑ PKG TX PLANT L1SAND OIL SEPARATOR(ENCLOSED SYSTEM) C <br /> W( LEACH LINES LEACHING CHAMBERS IY1h�TilAt1YS #OF LINES LENGTH OF LINES ft �] <br /> DISTANCE TO NEAREST WELL It FOUNDATION (t) ft PROPERTY LINE_ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION H PROPERTY LINE ft \� <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS Worm it LENGTH It DEPTH ft <br /> ,_,/ DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINEft <br /> V SEEPAGE PITS NUMBER L4 WIDTH Y It DEPTH 51 <br /> it <br /> DISTANCE TO NEAREST WELL I ft FOUNDATION IO it PROPERTY LINE it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATIONAND THE WORK WILL BE DONE IN ACCORDANCE u_ AN SJO WITH SAN AQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUINr�COUNTY. L d <br /> SIGNED TITLE O W 1YIATOY DATE -1 <br /> Le el��r <br /> Ver <br /> ` 8 2021 <br /> 1 <br /> co <br /> UiAN <br /> ENTAL <br /> RTiyENT <br /> DEPARTMENTUS ONLY <br /> /— /����� Date - Area <br /> Application Accepted y f Employee ID#�� <br /> Final Inspection By -'Iac Date 2� SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: It/S mp Soil Character: <br /> COMMENTS FC4 Ill t -Fx s rji'' E J'I:}IYIc 11 rl e-s 40 <br /> PE SC Received Che Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO ash Remitted -Request# <br /> Hai ;7-71 3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />