Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 4209) {2091468-n42n <br />NON-REFUNDABLE PERMIT CALL ?09 <br />j 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE[ <br />JOBADDRESSG�f`li� CRY/tIP A -c fm-" P G l SZ -Z O <br />/ <br />CROSS STREET l ii L- I V1n� I; -'ILS [A APN CU S - 14 S - 4 1 PARCEL SIZE <br />OWNER NAME_LL& NE <br />PHONE ' I <br />OWNER ADDRESS 31 / 2 y jZ7 , CRY/STATE21PA'`K'VYI f O C r� �'I ZZ Li <br />CONTRACTOR LI 0 C 1( NY-- C's(; �. E/V V(P C) r"JY'Y1 [r�TL/�I III <br />1 L �7 PHONE 7 bq ` q3-7 .� <br />CONTRACTOR ADDRESS 4y -1 w , C)'k(L S -'F . CRY/STATE/LIP L-�Cb <br />'}( C. A �'1 S 2-"0LICENSE (311C-42 00C.96 OTHER C �L NUMBER 2'iS 1 EXPIRATION DATE -T - <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X y <br />P< PERC TEST # <br />BUILDING PERMIT # <br />LENGTH OF LINES <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />❑ NEW INSTALLATION ❑ <br />REPAIR/ADDITION <br />0 ENGINEER DESIGNED/ALTERNATIVE <br />' <br />0 REPLACEMENT I.1 <br />OUT -OF -SERVICE SEPTIC SYSTEM 1:1 DESTRUCTION <br />INSTALLATION WILL <br />SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />j <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPEIMFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE R <br />13 LIFTSTATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />P. LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />❑ <br />❑ <br />❑ <br />❑ <br />11 <br />DISTANCE TO NEAREST WELL <br />FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />DISPOSAL PONDS WIDTH _ ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS NUMBERWIDTH <br />DISTANCE TO NEAREST WELL <br />it FOUNDATION <br />ft PROPERTY LINE <br />ft DEPTH <br />ft PROPERTY LINE <br />ft DEPTH <br />R PROPERTY LINE <br />ft DEPTH <br />ft PROPERTY LINE <br />ft DEPTH <br />R PROPERTY LINE <br />ft DEPTH <br />ft PROPERTY LINE <br />It <br />It <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />it <br />ft FOUNDATION <br />ft FOUNDATION <br />ft FOUNDATION <br />ft FOUNDATION <br />ft FOUNDATION <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 />MM"'WM <br />SIGNED <br />HOUR ADV14NCE NOTICE REQUIRED <br />��� <br />FOR INSPECTIONS <br />TITLE fl' -03 <br />- P1ESE CALL <br />01 & 0- • DATE 'I `Le -f - Z I <br />e <br />P-1 4 I PWeL i 'TanCEL 2 N <br />fw,n nc .n.ss-w. awi awH y, <br />PARC?L 3 w. m uA <br />< we <br />�FflC^7 <br />��6 MN{R4I <br />IN <br />a <br />g <br />0 <br />DEPARTMENT U E ONLY F j �J S-1--1/VY `)' <br />Application Accepted By 'i'r—�IGJ Date �'' Area �/� G Employee ID# d ` 16 01 �Q <br />Final Inspection By Date ❑ SPECIAL PERMIT - Approved bye% /RO G/NC <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: y�FAA T P,N <br />COMMENTS ? ,r <br />hT <br />PE <br />Code <br />SC Receivedec <br />INFO B <br />Amount <br />sh Remitted <br />Date <br />Permit/ <br />Service Re uest # Invoice # Permit ID# <br />Ll�a� <br />s�3 <br />)s,� <br />cI 21 /-1 <br />.. <br />42-01 <br />4/14118 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />