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 PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRE <br /> S 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 9(O-/D �vi <br /> L1 tvIJE � CRY/ZIP -T 12 /_ <br /> CROSS STREET Cf}��2 APIN 2-!;3�Z 10- 19 PARCEL SIZE w•LP4 A Y <br /> b <br /> C O <br /> OWNERNAME GuKSFrt13 <br /> A ' PHONE <br /> OWNER ADDRESS CRY/STATE/ZIP -/-tZlN:S�wfV <br /> 1pD ( <br /> CONTRACTOR L-'VE: OP�K PHONE 2�I-Ol <br /> CONTRACTOR ADDRESS q0-1 W- OA1e— <br /> - CITY/STATEIZIP L OV I GAY J SZ�'O <br /> LICENSE 00C-42 ❑❑C-36 OTHER Cy NUMBER �l� EXPIRATION DATE 4 3 <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 0 REPAIR/ADOMON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT L) OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING 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 It 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 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 It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 APPUCATION 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 /> MINIMUM48 HOUR A NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE AQ j- 141 GQ - DATE !Z- ( Z( <br /> 0 <br /> DE.P RTMENTUSEONLY <br /> Application Accepted By 1 Date j 7 7') Area Employee ID# Pte . <br /> Final Inspection By / Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft:U V Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received eck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />