Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTQN AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL("209 953-7697 FOR INSPECTIONS EXPIRES 'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 6gnQ-- CCIIT�YIZIIP 0, <br /> CROSS STREET �_/0'1 C//*HQ APN�r _ lJ PARCEL SIZE <br /> OWNER NAME ��� f NG�q ch I)""(( � PHONE v <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR ��✓l� mai "t Q PHONE 00y_ 3(0 _ <br /> CONTRACTOR ADDRESS P3 l' '/ G CITY/STATE/ZIP <br /> LICENSE ❑yC-42 ❑1 IC-36 OTHER NUMBER q5 OLI EXPIRATION DATE <br /> /` ( I fes\ <br /> WATER TABLE DEPTH: v ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION 1 ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: C RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG r /y C CAPACITY ( POO gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL Iao 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 7,,, #OF LINES�_ LENGTH OF LINES �� ft <br /> DISTANCE TO NEAREST WELL /30 ' ft FOUNDATION l / ft PROPERTY LINE o�O 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 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL Q ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER -.1— WIDTH TB ft DEPTH ':PS ' ft <br /> DISTANCE TO NEAREST WELL ASO 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE UyI�Ylt( DATE <br /> , V <br /> Q <br /> N N <br /> R <br /> EPA R TM&A 71 US E10 ALLY <br /> Application Accepted Dat Area Employee ID# <br /> Final Inspection By Date C SPE AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Fir". Pit/Sump Soil Character: <br /> COMMENTS O 7r. <br /> fPE SC Received heck A ount Date Permit/ Invoice# Permit I <br /> Code INFO B ash emitted Service Request# <br /> o �32t,s d`b 2 5e2005?6_4E - <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />