Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAIL JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> CITY/ZIP r+ <br /> JOB ADDRESS <br /> ,�//_,� <br /> CROSS STREET ,�,� APN '�//Il_� PARCEL SIZE 1.� <br /> OWNER NAME 1 V{- l Y s) i PHONE <br /> OWNERADDRESS CrrY/STATEMP <br /> CONTRACTOR_6M `IL-C� PHONE !-}�J�TI, / <br /> CONTRACTOR ADDRESS --=r=O &,X— `O`--�t� CITY/STATE/ZIP ^^ - o47 1*ft�' CA <br /> LICENSE t,:C42 sC-36 OTHERNUhIeER`.C1EXPIRATION DATE <br /> WATER TABLE DEPTH: f: GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ENGINEE DESIGNED/ALTERNATIVE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: �❑it(ESIDENCE COMMERCIAL —C OTHER <br /> UMBER OF LIVING UNITS: V NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG CAPACITY 7_��,g gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTM=NTS <br /> 1 <br /> DISTANCE TO NEAREST: WELL�}yy �jL_ It FOUNDATION 'KD) II�— ft PROPERTYLINE ,,o ft <br /> ❑ UFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES Ll LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTYLINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY UNE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELLIt FOUNDATION it PROPERTY UNE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS MOTH — <br /> ft LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH it <br /> DISTANCE TO NEAREST WELLft 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 /> f <br /> MINIMup 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 -7 <br /> SIGNED TITLE -4-,C DATE <br /> fJ <br /> N � <br /> i <br /> i <br /> I <br /> —— <br /> DEPARTMENT U i Oid <br /> Application Accepted By 1_ - _ _Daje _ Area _ Employee ID# <br /> Final Inspection By mow. ate 3 / ❑ SPECIAL PERMIT-Approved by <br /> Character Of Soil to Depth Of 3 Ft: USump Soil Character: <br /> CO tJv MENTS <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash I Remitted Service Request# <br /> �• < �. <br /> 42.07 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10;4/07 <br />