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-REFUNDAB PERMIT CAL/L(209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM PATE ISSUED <br /> JOB ADDRESS C <br /> 'I <br /> ITTY/ZIP Q7 7r�G <br /> CROSS STREET _�%/��,YC.P 1 APN 7, 7�/Jo -90 PARCEL SIZE v <br /> 0 <br /> OWNER NAME ��F 1 I I �I-( PHONE N <br /> OWNER ADDRESS T I/ �( %�, V -/�/ �J CITY/STATE/ZIP <br /> CONTRACTOR C / PHONE <br /> CONTRACTOR ADDRESS 1 CITY/STATE/ZIP <br /> LICENSE ❑i C-42 ❑. C-36 OTHER V v NUMBER j�O EXPIRATION DATE lJ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # F BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I I RESIDENCE I-I COMMERCIAL fl OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 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 ft LENGTH ft DEPT ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft R PH�' (�� 170"A 1 <br /> ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPT09CEIV ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ElSUMPS WIDTH ft LENGTH ft DEPTH' I ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft S..PR4P.9b1h1N!~.._.,r ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPiBNVIRnNMFNTAI ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft HEWWIE -PAWMENT 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 /> MIOMM48HO AQVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE <br /> .D PARTMEN4SEOhiY <br /> Application AcceptedBy Date Area Employee ID# <br /> Final Inspection By Date U ❑ $P IAL PE IT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/Code INFO B Cash emitted Date Service Re uest# Invoice# Permit ID# <br /> 06-7 9cc b � <br /> 42-01 <br /> 14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />