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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS _ S / (N1/z(7 142 CITY/ZIP_���6(JC��1I � Z <br /> rn <br /> CROSS STREET s k APN I�I -1!% _/ / PARCEL SIZE , p <br /> OWNER NAME /7�}u ��/ !'�� (/V i4o / PHONE 0'? <br /> OWNER ADDRESS / _CITY/STATE/ZIP <br /> CONTRACTOR Z_;Z �n�44[�/f ��/n P► PHONE���,JI 1&� <br /> CONTRACTOR ADDRESS fU2-. 7' l�/� i�. CITY/STATE/ZIP Z�/ ,� 67A gs'Z Jam_ <br /> LICENSE 011C-42 1111C-36 OTHER NUMBER&W61 DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 0 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: F, NEW INSTALLATION I I REPAIR/ADDITION ENGINEER DESIGNED/ALTERNA VE <br /> REPLACEMENT 11 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: )4—RESIDENCE ❑ COMMERCIAL 1-1 OTHER <br /> NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> D SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP_ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> D LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELT_ 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 /> MINIMM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 9/53-7697 <br /> SIGNED TITLE G S_D DATE1.01 1 -d <br /> 194 Aid if) <br /> N Ui <br /> T <br /> -D PARTMENT US ONLY <br /> Application Accepted A­ t <br /> Date 11 Z� Area Employee ID#Final Inspection By Date /� — �m ❑ SPE IAL PERMIT-Approved by <br /> 4 <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS �� �3a.Gt1GG7rCv`/, <br /> PE Sc Received heck#/ Amount ate Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted Service Request# <br /> 2 SK 002 1&01 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />