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 pp �1 CALL(209)953-7697FOR INSPECTIONS EXPIRESSI YEAR FROM DATE ISSUED <br /> JOB ADDRESS I Z T l tJ. I�I�•�l7LTS /��• CrrY/ZIP L. L)/- q S-13 a <br /> CROSS STREET. M ft N 7�'{- (y �) APN 113 -33v - 3 PARCEL SIZE I• V-1 Ac• <br /> �q �•►') 0 <br /> OWNER NAME f <br /> �E�•►'1') t IV J/ ENE,Z PHONE 3 V S - Lo(a <br /> OWNER ADDRESS CrrY/STATE/ZIP <br /> CONTRACTOR L^i\/E Or .,1e- GL OE1VVI re-a^ /I•� <br /> jm EnL. PHONE 3t[q <br /> 03 5 <br /> CONTRACTOR ADDRESS If O*1 w - V FF ML S I • CrrY/STATE/ZIP L'•O A I G►'°r S Z <br /> LICENSE ❑C.IC-42 ❑OC36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # > BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDMON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> O REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM O DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK 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:a 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 It 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 WIOTH ft LENGTH It 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 PROPERTYLINE 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 /> MINIMUM749 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE � � mGR• DATE 6t-L Z—Zd <br /> r i•• <br /> /i i i Vna wr uc <br /> 1/ f .................L...... <br /> .' <br /> f/ <br /> i <br /> ti <br /> li <br /> I' I <br /> I <br /> ;E p <br /> = p <br /> DEPARTMENTUSSONLY <br /> Application Accepted By l� Date I? �aT Area Employee[D# v F� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE Sc Receivedheck# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B s Remitted Service Re uest# <br /> ya 3 2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />