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 <br />CALL (209) 953-7697 FORINSPECTIONS tXPIKI=S I TCAK FKUrA IJAIM wauc� <br />JOB ADDRESS 14 Z6.5 <br />7 IV <br />CITY/ZIP- n <br />CAPACITY ZOO gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />(2400-03 <br />V9 OC) <br />CROSS STREET L ]'�.[/G <br />/p -/I <br />ed AIN <br />PARCELSIZE <br />SIZE TYPE OF PUMP <br />OWNERNAMEFp�lLjr-do <br />Ln m lo aI- • <br />PHONE ZOq-" <br />-5Z4 <br />OWNER ADDRESS�'I q � <br />�'^ <br />{®r MoLrt Pa 54 <br />CITY/STATEIZIP® C/- �� <br />, <br />CONTRACTOR �eI IC- <br />�� � (`� G 17aAJ 1rI ® <br />/CS40 <br />PHONE _ Z / 6 - 61) J1 <br />yrA <br />— 4/ ? S17 <br />CONTRACTOR ADDRESS r C <br />15 ox, �P � <br />CITY/STATE/ZIP 01 { �V7r <br />p <br />. CA qS� ( x, <br />LICENSE C42 I C-36 OTHER , r'1. NUMBER 1 <br />t26EXPIRA710N DATE_ .? I <br />�+y Z L <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />I PERC TEST # BUILDING PERMIT #---- LAND USE APPLICATION #_ <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINFFR nFCI( <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: 7-, RESIDENCE <br />COMMERCIAL OTHER <br />2 <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />TYPE/MFG / L <br />CAPACITY ZOO gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />) <br />DISTANCE TO NEAREST: WELL / D D <br />ft FOUNDATION ft PROPERTY LINE /S- O ft <br />3 LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT LJ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />yQ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES_ LENGTH OF LINES �5 It <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE It <br />❑ FILTER BED <br />WIDTH ft LENGTH <br />It DEPTH It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION ft PROPERTY LINE _ ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />_ It DEPTH ft <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION ft PROPERTY LINE fl <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE It <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />ASEEPAGE PITS <br />NUMBER 3 WIDTH 3 <br />1. 5" ft DEPTH Z ft <br />DISTANCE TO NEAREST WELL 1. 5'0-j <br />ft FOUNDATION 167 ` ft PROPERTY LINE ft <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. <br />MINIMUM 40gMMADVANCE <br />NOTICE REQUIRED <br />FOR INSPECTIONS <br />T�IIONS - CALL 953-7697 <br />SIGNED <br />'^ <br />r <br />TITLE ! V/-, DATE 5"0 -'Z T (] - W <br />Application Accept B <br />Final Inspection By <br />Character of Soil to D Dth of 3 <br />r <br />Date <br />Date <br />" Employee ID#r / y <br />PERMIT - Approved by <br />Pit/Sump Soil <br />��4-Cts G"�1k 7il�°W �T <br />ZZ <br />63020 <br />2 <br />i qUl� r <br />ONWFNTUN7-' <br />PE SC Received ChaokN <br />Code INFO Cash <br />Amount ate <br />Remitted <br />Permit/Invoi <br />Service Request # <br />Permit ID# <br />42-01 ,`,'//] ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114118 4'l L `��/ (��4�0� <br />