Laserfiche WebLink
r <br /> 4 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 EWNIL CALL(20N 9p3-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS .)(Ilw CITY/ZIP <br /> CROSS STREET S��i,,� /L APN © `'� `� Z PARCEL SIZE q' : <br /> c <br /> OWNER NAME 2��y/y�/'�/O �/J �// �P,H/ONF� <br /> OWNER ADDRESS `�l.^3'S J (Y LN �J�/ dl�l Oy CITY/STATE/ZIP <br /> CONTRACTOR C/` 0C <br /> r- (—T–, <br /> /�C PHONE <br /> CONTRACTOR ADDRESSA6- �� u'Y G / C CITY/STATE/ZIP <br /> LICENSE ❑ _IC-42 EIIC-36 OTHER A NUMBER ` EXPIRATION DATE :7.3 <br /> WATER TABLE DEPTH: 5-0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L' NEW INSTALLATION LI REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM /-----DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ 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 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES I 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 WELL 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 /> M�WMUM 4B HOUR ADVANCE NOTICE REQUIRED FOR INSPECTION - P EASE CALL 209)953-769 <br /> SIGNED TITLE �S1` Cr DATE �6y2o <br /> f <br /> u <br /> J <br /> U IR N U <br /> P <br /> --AW:: V <br /> EPARTMENT USE 6NLY <br /> Application Accepted By Date 202 Area Employee ID# <br /> Final Inspection By Date Z 6�� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS ArZ LJ <br /> r s - Ir <br /> Ced <br /> o t r C /u �_ <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# S <br /> Code INFO B Cash Remitted Service Request# <br /> k Py llzwlc) SiZw�l�g):�' <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />