Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMI1- <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PER�M-IyT� TCALL(209)953-7497 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS c�rC� ?V C" n / �� '_ - CITY/ZIP ao <br /> � <br /> H <br /> CROSS STREET d r*1f� ACad APN �� CI - O ^O PARCEL SIZE d <br /> d <br /> OWNER NAME C /�� �PH1Ot� q� Y` 2a� �� <br /> OWNER ADDRESS G CITY/STATE/ZIP `fCFI 9_S1J�O <br /> CONTRACTOR - PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# 3-1060 t!g— LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Nr RESIDENCE 11 COMMERCIAL 11 OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES:_ <br /> 5?' SEPTIC TANK TYPE/MFG MOO�,I.SP L (,&jCtjge CAPACITY lygal #OF COMPARTMENTS <br /> lei GREASE TRAP TYPE/MFG �— CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL /00 ft FOUNDATION © ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I� LEACH LINES ❑ LEACHING CHAMBERS 4� f iT e #OF LINES LENGTH OF LINES _/ ft <br /> DISTANCE TO NEAREST WELL 1 a5 ft FOUNDATIONX'ft PROPERTY LINE ft <br /> I 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 FOUNpATION ft PROPERTY LINE ft <br /> �[ '/ a57 ft <br /> l�f SEEPAGE PITS NUMBER � WIDTH -T ft DEPTH <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION ft PROPERTY LINE 5- <br /> 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br /> SIGNED y� TITLE DATE <br /> vir <br /> it <br /> J <br /> R � <br /> Q P <br /> T <br /> to <br /> DEPARTMENT USE ONLY 1� <br /> Application Accepted Date 3 ZOX Area Employee ID# <br /> Final Inspection By 'u:T i Date QD�D ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pi Sump Soil Character: <br /> COMMENTS <br /> PE Sc Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B a Remitted Service Re uest# <br /> rail 0 o t <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />