Laserfiche WebLink
ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />TYPE OF WORK: NEW INSTALLATION ' REPAIR/ADDITION <br />‘)( REPLACEMENT te111K OUT-OF-SERVICE SEPTIC SYSTEM <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT* <br />LAND USE APPLICATION <br />WATER TABLE DEPTH: 0 - I 0 <br />fl PERC TEST # <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 0 <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 6 7 Z7 e Hat, A+ f2d CITY/ZIP 1,0 4y <br />CROSS STREET N An? 16:'Ir's APN 0(11150 /-13 <br />OWNER NAME --i CL C. e y •S -1--C o <br />OWNER ADDRESS 6 9 / Q L-- 0 ct , 4.-/- CITY/STATE/ZIP <br />CONTRACTOR 5 el:3+1 G.- Se r0 r ce c. G. izou.p. PHONE i ii) — 366- /II1 <br />CONTRACTOR ADDRESS PO 15 n x 5-69 CITY/STATE/ZIP EL), 14-0,) C4::4 956''3i <br />LICENSE C-42 C-36 OTHER ' 4A" NUMBER i 0 el fs106PIRA11ON DATE S --....4 1 ---. Z-0 Z7_ <br /> <br />INSTALLATION WILL SERVE: I RESIDENCE I COMMERCIAL I OTHER <br />f <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: I - - 3 • NUMBER OF EMPLOYEES: <br />PHONE <br />PARCEL SIZE <br />X SEPTIC TANK <br />0 GREASE TRAP <br />CI LIFT STATION <br />LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br />DISPOSAL POND <br />S. SEEPAGE PITS <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />S WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />NUMBER <br />DISTANCE TO NEAREST <br />LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br />SIGNED -(4 <br />$40/ <br />4/- <br />74 :SSDRICIV 31IS TYPE/MFG CalrOC_. / L <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL (?.. C ' <br />SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />CAPACITY I Z- CC> gal # OF COMPARTMENTS <br /> -z. <br />CAPACITY <br />gal # OF COMPARTMENTS <br />ft FOUNDATION t ) <br />ft PROPERTY LINE / ft <br /> # OF LINES Z. LENGTH OF LINES q Z_ ft <br />WELL Ze0 ft FOUNDATION z s-- ft PROPERTY LINE / () It <br /> <br />ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> <br />ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> <br />ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH 3 I ft DEPTH Z. •s--- ft <br />WELL z co + ft FOUNDATION Irt=1. 0 ft PROPERTY LINE / 0 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 />MINIMUM 48r . fIVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />TITLE )2 /1-t (..-:-7-- DATE 7 - (7 - 2 1 <br />-1-6t <br /> it <br /> riff <br />Tirz <br /> (A) tA-3cr <br />Poi <br />"\Q ^ <br />Application Accepted B "----. ''.- -----:: - Date -.VIt' iji..7 i Area 9 / C./ CI Employee ID# <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS -ri ,..,.. 4,- c f,,s C.:/, ritt 1e r li Iv ,lq <br />Final Inspection By Date 5 / A242-i . SPECIAL PERMIT - Approved by <br />,DEPARTMENT US ONLY <br />L: i ri I') i,14 e E a i .:,C, 'le', t ( 7 rr./ <br />0 <br />e CI4 e-C 'Etti I 10 m; <br />P <br />Code <br />SC <br />INFO <br />/ <br />Receivd i - Check#/ <br />Cash <br />Amount <br />Remitted <br />1 ,.....- <br />Date Permit/ <br />Service_Riquest # <br /> , <br />Invoice # Permit ID# <br />H a i 0 )1C <br />By..V <br />MA <br /> <br />f 01- 4 3 D D 91141124 5 e-C)0 '330' <br />42-01 <br />4/14/18 12 <br /> <br />AL-fLel <br /> <br />I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />