Laserfiche WebLink
r <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT .�I CALL 209 953-7697 FOR INSPECTIONS ��-.yE�X.P.IIR,E�S 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Zollyj/aa AA F. GWCWwo 40• CITY/ZI <br /> QP 51•^�fti '75-2 JS <br /> CROSS STREET 441 K� ' 4 M A�P/,NN /P �--MVe.0--3r /PARCEL SIZE 29 <br /> OWNER NAME G 1T- MucPNr )914r -td AC_lI C/twf1* - Au i �/ PHONE ( 'I� — (0/6 Z <br /> OWNERADDRES9 �VM M'YW�D '^7�E CITY/STATE21P 1-55ckl�ao /c+ q <br /> ! `fZ)o <br /> CONTRACTORQ"`�� �f� p PHONE (-*) �'17Y4613CONTRACTOR ADDRESS I 0- y�X !i1 W CITYISTATEMP"%/ C4 2-!Y/ <br /> LICENSE ❑LIC42 ❑LC36 OTHER r�r <br /> "v q5�-1,NUMBER 5 d� EXPIRATION DATE �o <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: I i NEW INSTALLATION I I REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> I; REPLACEMENT I I OUT-OF-SERVICE SEPTIC SYSTEM 11 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 11 COMMERCIAL O OTHER <br /> NUMBER OF LMNO UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG 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 U LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH it <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWSAND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 H011I�4BiTAi110ENOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE /" C C/r-- DATE �2Y- <br /> 1gm <br /> DIP <br /> ifill <br /> F y4fe10 <br /> • / I Vg j.A 00 CEIVF0 <br /> ?020 <br /> OAQU <br /> DEPARTMENT US ONLY !� @q�T RONME ouNn, <br /> Application Accepted By _ Date I I d`l aD db Area C C Employee ID# A 113EPgRNTAC <br /> Final Inspection By Date ! 1/7LZ ❑ SPECIAL PERMIT-Approved by MINT <br /> Character of Soli to Dap of 3 t: PIOSump S 11 Character: <br /> COMMENTS I Z ul <br /> PE SC Received ec Amount Date Permit/ Invoice Permit ID# <br /> Code INFO B Cash Remitted ervlcee uest# # <br /> aaa sa3 �3 <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />