Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE,/ m PERMIT CALL 209 953-7697 FOR INSPECTIONS } EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1�7 � � Cpt"50- � <br /> - E CrrY/ZIP tXCC�C"'J 'IT3 7 �! <br /> 1 � <br /> CROSS STREET K C/V/J cr>� APN Z o^1-3 Z0-ZI "i I Z 1 r b <br /> (_� 7 CEL SIZE z'L'6-�7 7�'C• <br /> OWNER NAME H'L C/�'Tb�J - W SDA ] r op-e ri es LLL PHONE 4 0 <br /> C, G � <br /> OWNER ADDRESS /07 -5 C�rn('tit L-L AVE- CITY/STATE/ZIP �C H'L-ON CA /S-3--d <br /> CONTRACTOR LIVE OPCIL G�OGN�JI�On/N'1[.�Ji7r1- PHONE 3tp�-0375­ <br /> CONTRACTOR ADDRESS �� W 6?a-- .5—1 r CrrY/STATE/ZIP <br /> LICENSE Ell-IC-42 ]DC36 OTHER C E CT NUMBER Z I•� ( EXPIRATION DATE -4 3 --2'-4 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 0 NEW INSTALLATION ❑ REPAIR/AODMON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 11 REPLACEMENT CI OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LJVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMEN7S <br /> ❑ GREASE TRAP TYPEIMFG CAPAcrrY 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 f::1 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 WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> EAREST WELL_ <br /> DISTANCE TO Nft 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 /> MINIM✓UM':48 H_OU[R/A/flQ17ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED i �! `l TITLE POJ• G"?. DATE II - ID`ZO <br /> 0 <br /> MIN M <br /> - 171 <br /> �.�_ <br /> --- ___--,—-- - J N left <br /> ONE TREE ROAD <br /> -- ITF1T TTITT F- - - - - - ENTAL>y <br /> DEPARTMENT USE ONLY 'ARf' TMENT <br /> Application Accepted By �; Date /I�C�an � Area 7 Nq Employee ID# A 67 <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 Received Amount Permit/ Invoice# PermitlD# <br /> Code INFO B Cash Remitted Date Service Re uest# <br /> 4141/18 <br /> x//14ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />