Laserfiche WebLink
f 1 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 96206 - (209) 468-3420 <br />NON-REFUNDABLEPERMIT- CALLS 953-7697 FOR 1NSPECTioNS EXPIRES 1 YEAR FROM <br />MDDATEEo ISSUED <br />JOB ADORES:. rrt t,sr'}' 1? -,'t,33 Onc' 1�'; e -y 1�0 clTY'zlP L44 r eA 4 J J 7 <br />CROSS STREET F'r ta.w-t �- tAb,._.�. APN I ! r t (j "' 2,-- PARCEL SIZE _�Ly'� <br />OWNER NAME C Jt.A.Ce5 �1CL/1� lnc PHONE�„�„_4W-222LJu , <br />OWNER ADDRESS <br />J�y i.% L '...iQ.i A6� IQ(Q CITY/STA7ElZIP h�i.n1h" y!".^� 'i�TL <br />CONTRACTOR 4C A a L- PHONE <br />CONTRACTOR. ADDRESS — k--- -��--, CITY/STATEIZIP_w�WA--,„e4 <br />LICENSE [..1l:`C-42 0!:C-36�r C-36 OTHER ` NUMBERG& SS EXPIRATION DATE. � r#0 <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />�i.,' FERC TEST # <br />r BUILDING PERMIT # J <br />LAND USE APPLICATION # <br />TYPE F WORK: <br />_ <br />I', NEW INS�ATIO AIRIADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT 3,i OUT -OF -SERVICE SEPTIC SYSTEM- DESTRUCTION <br />` <br />INSTALLATION WILL SERVE: SIDENCE 0 COMMERCIAL <br />j� <br />...I OTHER <br />j <br />NUMBER OF LIVING UNITS: l NUMBER OF BEDROOMS:,,j I <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPEIMFG CAPACITY <br />gat # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL. ft FOUNDATION <br />it PROPERTY LINE <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP 13 PKG TX PLANT <br />© SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />U -LEACH LINES <br />7 <br />LEACHING CHAMBERS # of LINES LENGTH OF LINES � h <br />Amount Permit/ <br />Remltted Date Service Request # Invoice # Permit ID# <br />DISTANCE TO NEAREST <br />WELL j A ft FOUNDATION h ft PROPERTY LINE It <br />❑ FILTERSED <br />WIDTH _ <br />ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH it DEPTH It <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION it PROPERTY LINE it <br />❑ SUMPS <br />WIDTH „-_ <br />ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH ft DEPTH It <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTHft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL R FOUNDATION R PROPERTY LINE It <br />I HEREBY CERTIFY THAT <br />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 48 <br />HOUR,AaVANCE NOTIC <br />REQUIRED FOR 1 -PLEASE 2953-7697 <br />SIGNED <br />TITLE �Ctf' t % f rCi"-4-j r DATE j <br />Application Accepte By <br />Filial inspection By <br />Character of Soil to Depth of 3 <br />COMMENTS A,,}ti,Iv <br />A0.i l ................ irfiox. <br />` DEPART t S N Y /'')n <br />to . .. <br />Date VZI..0Area Employee ID# <br />Date €i D SPEIAL PERMIT - Approved by <br />Pit/Sump Soil C_tlaracl _ <br />PE SC Raceived <br />Code_ INFO B <br />-" <br />Check#/ <br />ash <br />Amount Permit/ <br />Remltted Date Service Request # Invoice # Permit ID# <br />___ ...At <br />2cTt7 3Q Db 4fJ 6� <br />42.01 ONSITE, WASTEWATER TRTMNT SYSTEM PERMIT <br />4114:18 <br />0 <br />F <br />9 <br />