Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JO�AQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 299 t9n53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ' , (," CITY/ZIP tZY� 7.0 1 v <br /> CROSS STREET I�nII� APN-U-71 - y '!�-O - Q z- (/PARCEL SIZE <br /> OWNER NAME �15J I I C IIr �. PHONE ( � 1) <br /> OWNER ADDRESS J � 7 �`� CITY/STATE21P _C��('X.IV <br /> CONTRACTOR , I I�� �� E, J PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE I I C-42 C-36 OTHER NUMBER 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/ALTERN VE <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 CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION It 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 DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH PA It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ivi -ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH AS ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE N JOAp ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH HE4�T It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE NT It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED 6�- ' TITLE /G /?�e'/� DATE — <br /> Al L <br /> D PARTMENT S ONLY <br /> Application Accepted y Date Area Employee ID# __ <br /> Final Inspection By Date I I SPEC AL PERMIT-Approved by <br /> Character of Soilo Depth of 3 FII : 1- Pit/Sump Soil Character: <br /> COMMENTS �e j, l (Q ii XPi/ L D�IK L"L�' ru C �iC LQz <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Re u st# <br /> 600 )-16U42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />