Laserfiche WebLink
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 09 953#697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS ) CITY/ZIP y^ <br />CROSS STREET /w 0. !/1 APN o 8 q rkag a PARCEL SIZE f �j <br />OWNER NAME %�' % PHONE RZ 'Y�1 <br />01 <br />7e�nG' <br />OWNER ADDRESS 4210 >ofL�e �C"A CITY/STATE/ZIP <br />CONTRACTOR /"%A/1/1nV, 7U ?A,1 J��1<<-� • PHONE <br />CONTRACTOR ADDRESS CITY/STATEIZIP <br />LICENSE -42 ❑ C-36 OTHER NUMBER J EXPIRATION DATE -'3) <br />WATER TABLE DEPTH: A V D� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION _}iEPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT f —OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION / 6 11 k <br />ly <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL pei❑ OTHER <br />NUMBER OF LIVING UNITS: )NUMBER OF BEDROOMS: PG^�l` e� v zue`i NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG, C__ CAPACITY / �— gal # OF COMPARTMENTS_ <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL f]�f ft FOUNDATION "� ft PROPERTY LINE S <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES Eft <br />DISTANCE TO NEAREST WELL7._ ft FOUNDATION ft PROPERTY LINE ft <br />❑ 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 />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER j WIDTHft DEPTH r ft <br />DISTANCE TO NEAREST WELL ,4: 1; ,1 ft FOUNDATION %7ft PROPERTY LINE 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 />mlwaam 48 HOLWADYANCE NOTICg REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7J697 <br />SIGNE TITLE C Z� DATE :2 / L� <br />DEPARTMENT USE ONLY U / <br />Application Accepted By Z Date s' /S" visa? Area 1 Employee ID# rrn✓I'r v <br />Final Inspection By LrGlacki Er (L'Lry;F. A" L Date q1'( (22, ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS O161'0Wrl- , r tln eccl^ )I PS GiCt'] _56'J5 cos <br />eGf � "'( )"'(J Int li l th ApX, OR°10R 7'::� <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />he <br />Cash <br />Amount <br />Remitted <br />Date Permit/ <br />I I Service Request # <br />Invoice # <br />Permit ID# <br />Lld 10 <br />Hs - <br />6 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />