Laserfiche WebLink
CROSS STREET LCO/IMel <br />OWNER NAME lor, 6A kfilk)14 <br />JOB ADDRESS /9/<2 ,5 S. C_orca_-/ • ciTymp -27-4 Cy <br />APN 01,90g 006 <br />OWNER ADDRESS S61 VII-e" CITY/STATE/ZIP <br />CONTRACTOR ADDRESS <br />LICENSE EC-42 FJ C-36 OTHER <br />CITY/STATE/ZIP <br />NUMBER 54Lt/ r,)-7 EXPIRATION DATE (-0 <br />LAND USE APPLICATION # BUILDING PERMIT # <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />TYPE OF WORK: E NEW INSTALLATION , <br />g REPLACEMENT lec't <br />WATER TABLE DEPTH: 196s I 0 ft GEOGRAPHICAL INFORMATION: Coordinates X <br />E PERC TEST # <br /> <br />INSTALLATION WILL SERVE: g RESIDENCE E COMMERCIAL y.),J ( F., c'e) C OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: '1 (0 NUMBER OF EMPLOYEES: <br />9 5 D <br />PARCEL SIZE d <br />PHONE <br />CONTRACTOR 56x -en1. PHONE 2.4)1 - '37;25 <br />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 CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />or SEPTIC TANK TYRE/MFG <br />CI GREASE TRAP TYRE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT El SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />A LEACH LINES 7 ' LEACHING CHAMBERS E.- a.7.--x,, # OF LINES g LENGTH OF LINES /60 ft <br />DISTANCE TO NEAREST WELL 00i, ft FOUNDATION AO -71- ft PROPERTY LINE /0 • I - ft <br />CI 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 ft PROPERTY LINE ft <br />LI 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 <br /> ft FOUNDATION <br /> <br />ft PROPERTY LINE <br />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 />MINIMU UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <br /> <br />TITLE (On A6 cli47 - DATE 5 32 I :SS3NCICIV 31IS 5e <br />MAR 1 5 204 <br />sAA, <br />Huck., IrAlii-ailAUoutvrY rA, ri <br />DEPARTMENT USE ONLY <br />Application Accepted By • --- - • Date //.S -' 1 Area Employee ID# <br />Final Inspection By C-**)-N,/\. Date "5 I -1/t E SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/S mp Soil Character: <br />COMMENTS Fe, I' K..s C.Thn Frel Gte c+4-eCi/70 vie Li can pail el tier., t'y' ho 1.4 e rcu11 (;)-11 -11e%6-i 01 <br />sforied 1/411 ot, iveo Ovc pro po.sPc,/ I oe,,, i-PcCei4 //lICS no boe roveree/ <br />in <br /> <br />cont.reEj aspildf a rc, ive,y, ()vein <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ Amount <br />Remitted Date Permit/ Invoice # Permit ID# ask) <br />1-) 0 1 L-I i ) ,s- Ut 5 P - 6 ,41,--0-' 1 , It 00 1012-1 Service;33 uest # smsie <br />42-01 <br />4/14/18 <br />ONSITE WASTEWA ER TRTMNT SYSTEM PERMIT <br />yAi4 t <br />baciale_ Cee i-t;r )111-od per Yr