Laserfiche WebLink
01 - <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2 I `V _ C"/ZIP <br /> CROSS STREET W OS`�^J j 0 1` _ APN I =1 ___._ PARCEL SrZE <br /> L 7 <br /> c `4 A <br /> OWNER NAME J 11-j __ __PHONE NIS _ .•�'n <br /> OWNERADDRESS 7f\ML AS ^3JJU CIITY/STATEIZIP <br /> CONTRACTOR WtS-S C,��S'1 SS i'04 Atte---L'i l0-:0(7IPHONE 4_9, �.-- G(S(-Lz -- <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS '�3 ��L1 xiVt11 S� CrTY/STATE/ZIP LJO-L.. ._CIA -1SZ`I� C <br /> LICENSE QC-42 '-C-36 OTHER— `-'J11S NUMBER 'Z—EXPIRATION DATE <br /> WATER TABLE DEPTH: �10 it GEOGRAPHICAL INFORMATION; Coordinates X _ Y <br /> ❑ PERC TEST #_ 9UILOING PERMIT# OLAND USE APPLICATION#--PA,- I IZ <br /> TYPE OF WORK: NEW INSTALLATION L REPAIR/ADDITION i ENGINEER DESI NED/ALTERNATIVE <br /> 7 OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE NS COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: �[ NUMBER OF EMPLOYEES: <br /> la SEPTIC TANK TYPE/MFG i L - CAPACR1{�"_/ 1 6U� gal #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPE/MFG —_ CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL S:> it FOUNDATION 10 It PROPERTY LINE -5___ ft 7 <br /> ❑ LIFT STATION SIZE __- TYPE OF PUMP____O PKG TX PLANT Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> _ <br /> E3 LEACH J� <br /> LEACH LINES LEACHING CHAMBERS MOF LINES LENGTH OF LINES <br /> 1..IN1`� fq'�� 3 <br /> l1�O ft <br /> DISTANCE TO NEAREST WELL_ .� it FOUNDATION 1 C2 it PROPERTY LINEC it <br /> ❑ FILTER BED WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE _It <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH C fl <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE �. / It <br /> ❑ SUMPS WIDTH it LENGTH it DEPTH S it <br /> DISTANCE TO NEAREST WELLit FOUNDATION It PROPERTYLINE il <br /> J• ,/O � It <br /> ❑ DISPOSAL PON DS WIDTH H A'Y <br /> LENGTH ft DEPTH _ <br /> DISTANCE TO NEAREST WELLft FOUNDATION h PROPERTY LINE'4F� It <br /> SEEPAGE PITS NUMBER WIDTH S it DEPTH LS --eNr-- it <br /> C <br /> DISTANCE TO NEAREST WELL _ If FOUNDATION 1p it PROPERTY LINE_ J —it <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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE 9 �)I*Z"`Ot"-._I DATE., 2l- ')] <br /> ' 3- <br /> w�v <br /> i — I LF# <br /> -- <br /> I <br /> I <br /> fo' <br /> 1 T <br /> wnl <br /> DEPA RTMFNT USE ONLY , __7 �, <br /> Application Accgpted Data go Q- Area ._ Employee ID#A�q_s�e.c-f•c� <br /> Final Inspection B� / <br /> Date �� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to 9 pth of 3 Ft: _ Pit/Sump Soil Character; _—_— — <br /> COMMENTS __j_a' �' l- !�� i r �1� - J l� 5 ` <br /> 4f(,L.�L— ly-Z 7Llf_�/�/1 /iih /� /`LL �_�iV •�//LS'__/LCl7Ji��11�-L7-�+�G+rc•^._lccL_� <br /> PE SC Received Che Amount Date Permit] Invoice# Permit ID# <br /> Code INFO 8 Cas <br /> Remitted Service Re uest# <br /> um��5/' >`e nr �i r•� ss� ,� /�rpai/7n�;�j�s� �ol,� G r <br /> 42-Oi '7r ` �. .;,:�} u. ONN SITE WASTEWATER TRTMN7 SYSTEM PERt(T <br /> 4/24/12w. <br />