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 209 953-7697FOR INSPECTIONS --EXPIRES 1 YEAR FROM DATE ISSUED <br /> JO�`ADDRESS I i A 14 E. r-•1`-P.1/I C1,h //f i,-4 � �,2 d CIw/ZIlIP 4 Ora j& C'_a / •moi ,�CZ �. v-i' <br /> NCROSS STREET IS nn�ir �d p (v AP��N 33//££� s L-- it 0-3 PARCEL SIZE <br /> -[} ,L"(' <br /> OWNER NAME ���� C.I mg � I 8F s I LJ L- o PHONE (2O�) ;9 <br /> OWNER ADDRESS 'VC! •.,h(! )( !,�o / CIN/STATE/ZIP Later e .CJi rl <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CIN/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# 5 i LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> .� <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM 4 DESTRUCTION INAF1 u44- 4 <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <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 It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTYLINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 THISAPPJ.AC/NION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE SAND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 2,HQVR ADV SOT REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGN TITLE. �i^r?/0a/=,/�nr G//I6ggrDA J� <br /> r <br /> L NI <br /> DEPARTMENT USE ONLY <br /> Application Accepted By - r,Wr ` Dated 'L - Area a' ' Employee ID# - <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS P � r )Io- ye S <br /> PE Sc Received Check#/ Amount Permit/Code INFO B Cash Remitte Date Service Request# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />