Laserfiche WebLink
a4l'•elv- <br /> 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 If y CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS f I W 9 r(� /. CITY/ZIP Aca n700, C-}_ II ��Z D <br /> CROSS STREET �C��/Ca M�1i2o 12D APN 0I O —1/ 'P/ARRCEL SIZE <br /> OWNER NAMEA;c L &t-em PHONE 1 p - 1910 <br /> OWNER ADDRESSn�yZ_ 1S {/Mpn �F, Nto/ CITY/STATE/ZIIP� �Q <br /> CONTRACTOR l'P-r&f C, / �C{�I�ll) �1L�p-1]` PHONE �,[O-/ 3J�7 50�ar 7 <br /> CONTRACTOR ADDRESS �3 ILQ 0I so h �Y CITY/STATE/ZIP /-0 1 , <br /> LICENSE I !X C-42 � C-36 OTHER NUMBER 0TS EXPIRATION DATE <br /> '` r <br /> WATER TABLE DEPTH: 0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> X, REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE I COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> XSEPTIC TANK TYPE/MFG 6o cY 710-:JL- CAPACITY /,200 gal #OF COMPARTMENTS_ Z <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> i <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION�� ft PROPERTY LINE IDD 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 <br /> DISTANCE TO NEAREST WELL FOUNDATION30 ft PROPERTY LINE /00 ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH (t <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 It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER : WIDTH T .� ft DEPTH �S' ft <br /> DISTANCE TO NEAREST WELL�� / <br /> ft FOUNDATION "/Q� 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)''9//53-7697 / <br /> SIGNED 4Q TITLE 494"r DATEVC <br /> t. <br /> 1 <br /> 41 J <br /> � C <br />