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 2 PERMIT CA/LL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS (�7 s J V C�.�1/' C lh- �J CITY/ZIP %�`c/� f J-3 <br /> ,� /-c APN -� y�'2- 4/0 Z ' PARCEL SIZE i o <br /> CROSS STREET X <br /> OWNER NAME 1- e 5 �`1 Z f —PHONE <br /> {^ <br /> OWNER ADDRESS -CITY/STATE/ZIP <br /> CONTRACTOR )/ ,�T� r PHON(ES C)C1-) <br /> CONTRACTOR ADDRESS CITY/STATE/ZIPU�J )J 3✓�l' <br /> LICENSE ❑JC112 ❑L!C-36 OTHER NUMBER?/-)-L�J 2 EXPIRATION DATE '' J <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# od?DOo?6 LAND USE APPLICATION# <br /> TYPE OF WORK: 9 NEW INSTALLATION REPAIRIADDITION x ENGINEER DESIGNED/ALTERNATIVE <br /> L! REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> EINSTA:LLAT:ION:WILL SERVE: 1 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> F LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> I SEPTIC TANK TYPE/MFG o �L J� CAPACITY l w gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG / CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL / } ft FOUNDATION ft PROPERTY LINE -S ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES V LEACHING CHAMBERS �+`�4.�1/.O #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> FILTER BED WIDTH / 7 ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WE1­L_/0:J ft FOUNDATION S 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 /> MINIMUM 48 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE ,tir/ '� DATE <br /> F Vj l <br /> Np N <br /> DEPARTMENT USjF ONLY <br /> Application Accepted By z'z— Date /0 3% Jona Area 5 Employee ID# <br /> 1i -r+ <br /> Final Inspection By Date 1 I � L���► ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS ,Second SFP-_ ,,eyS�C'YY) GPs1SY1edaS p>vt S-<.NLS de_H,----' Glet'Pd JOhaaat, <br /> 6610ncJ deV1UFe ;►� C�It?Slah�U1P �I <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By ash Remitted Service Request# <br /> Hai I1-3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />