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)953-7697 FOR INSPECTIONS/ EXPIRRyES 1 YEAR FROM DATE ISSUED <br /> ir- <br /> JOB ADDRESS S�2L) ��NGOOX) 12O• CITY/ZIP W,� [SZ�Z-- <br /> CROSS STREET �101J QAhkV APN oS S- l4y- - PARCEL SIZE Zl-f�S Acca C <br /> zn2-163!�L <br /> OWNER NAME �\�Jc. ��M�l _PHONE � � <br /> OWNER ADDRESS +� IL cTT l� ✓fv-I�. L- uJr CITY/STATE/ZIP L--N[)% { (-Vit SZ--tZ <br /> CONTRACTORHE-%u D• W jwnoc9,vj W3X C� Ty�' AJ '''Wµ}1 PHONE (�1 36�' �O\ <br /> CONTRACTOR ADDRESS �0Z 1Pj V7 S'(IU?'L W,-�-y CITY/STATE/ZIP <br /> LICENSE C42 C-36 OTHER G-5� NUMBER �/O6`1 D0 1./ EXPIRATION DATE 3a ZOO 5 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # 2 1 r BUILDING PERMIT# _ LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: REstOENCE C COMMERCIAL C. 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 If 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 If <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH If DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL __ ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH K DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH _ ft <br /> DISTANCE TO NEAREST WF.I.L ft FOUNDATION If PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIMMUK 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNS _ _ TITLEi~1t7YlLe`�wZwLfL ��c'irw�'KT DATE 5//X <br /> A <br /> 1 <br /> 1 <br /> L� <br /> D P A T T P �{- <br /> Application AcceTpthof3' Ft:Al <br /> �� Date �� Area GCJ�J- Employee ID#rJ"!th <br /> Final Inspection B - Ze ��F C SPECIAL PERMIT-Approved by <br /> Character of Soil to Pit/Sump Soil Ch�lracter: <br /> COMMENTS C4+ <br /> PE SC Received Ph-_W Amount Date Permit/ Invoice# Permit ION <br /> Code INFO B h Remitted Service Request If _ <br /> 4221 S-0 y 13P — X r 6,eeo708 <br />