Laserfiche WebLink
LI ENGINEER DESIGNED /ALTERNATIVE <br />OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION fy 11 k, <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPLACEMENT <br />0 REPAIR/ADDITION <br />Application Accepted By <br />Final Inspection By . „ • (411.•-• <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS )r eillo <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />(Qhecls#Y Amount <br />Remitted , <br />Permit/ <br />ervice Request # Invoice # Permit ID# _ Cash <br />1-P 1 07 Se— /1/0775 ,x0o2/ ..f1 .2 <br />----) <br />ate/ <br />2( LS 00X . <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 <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 />JOB ADDRESS / 3 c 6z)c.vi <br />CROSS STREET A 61 <br />OWNER NAME 1L-Cy 1-12) <br />OWNER ADDRESS F;C-41 <br />CONTRACTOR 4)-e9(-- .5`y-L <br />CONTRACTOR ADDRESS /3,- 4/4( Z 7 <br />ciTyaip 72-e1A-4,4„;:cy"c3."...z <br />APN 3ot-1050-x-4 PARCEL SIZE ) <br />PHONE <br />CITY/STATE/ZIP ocilcdcile <br />PHONE ,002c24Cf " 6/9 <br />CITY/STATE/ZIP <br />LICENSE Li C-42 11C-36 OTHER NUMBER /'i 3.567/ EXPIRATION DATE j I <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # :ssaticiav 3lis INSTALLATION WILL SERVE: C RESIDENCE <br /> 0 COMMERCIAL <br /> <br />Li OTHER <br />NUMBER OF LIVING UNITS: <br /> <br />NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br /> ft <br />LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LI LEACH LINES CI LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />LI FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />LI 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 <br /> <br />ft FOUNDATION <br /> <br />ft PROPERTY LINE <br /> ft <br />1 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 />MINIiWUM 48 H <br />SIGNED <br />NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />TITLEL:‘,24,Za, DATE 7- <br />TT/ 4 c <br />PAYitimNT <br />RECEIV.- <br />AtAN 4 <br />SAN joAci, <br />ENV/ U161 CDUN RONAIE, TY HEALTH in E , "TAL - 1-41iTNIEN/ <br />1021 <br />DEPARTMENT y7 ONLY <br />Date <br />Date 314 Octi <br />Area ,C/I'lleW!-tect--• Employee ID# <br />III SPECIAL PERMIT - Approved by