Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 E. HAZELTON AVENUE - STOCKTON CA 95205. (209) 466-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS / —0 7lfi Ytv f _ j tfjW..I;- /--O4O CITY/7ZIPP �GILT!7Z41 iOd <br />3 ' o <br />CROSS STREET eu, I R APN 0 O � Z % D ` PARCEL SIZE <br />OWNER NAME / I`l��l S PHONE <br />OWNER ADDRESS CITYISTATEIZIP <br />CONTRACTOR /aILrI;1C PHONE O <br />0 / <br />CONTRACTOR ADDRESS [%'i i1641 ,161k CITY/STATE/ZIP r"f <br />LICENSE ❑ -42 <br />❑OC -36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: Xl / �O it GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # AND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAWADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br />D REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM E DESTRUCTION <br />INSTALLATION WILL SERVE: E RESIDENCE E COMMERCIAL E OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPEIMFG Y L CAPACITY el-;k*D gal # OF COMPARTMENTS oZ <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />� ,,JJ <br />DISTANCE TO NEAREST: WELL /Sa R FOUNDATION � it PROPERTY LINE z / it <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />q/ <br />LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES a <br />LENGTH OF LINES <br />SS ft <br />r <br />DISTANCE TO NEAREST <br />WELL �� / R FOUNDATION -)C / <br />R PROPERTY LINE <br />�� , it <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />it <br />DEPTH <br />It <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE <br />It <br />❑ <br />MOUNDED <br />WIDTH <br />R LENGTH <br />R <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />It <br />❑ <br />SUMPS <br />WIDTH <br />R LENGTH <br />- R <br />DEPTH <br />R <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE <br />ft <br />O <br />DISPOSAL PONDS WIDTH <br />R LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE To <br />WELL <br />R FOUNDATION <br />fl ,PROPERTY LIN, <br />R <br />If <br />SEEPAGE PITS <br />%NE�AIREST <br />NUMBER � <br />WIDTH <br />I/? ii ft <br />DEPTH �S <br />ft <br />DISTANCE TO EAREST <br />WELL /So ' ft FOUNDATION &P <br />R PROPERTY LINE <br />it <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DOME IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />DATE /Z <br />Area 14 /fY Employee <br />"1D# � r, <br />E SPECIAL PERMIT - Apb 2p�.rrr� <br />Soil Character: i.��_�� 11�� r <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114118 <br />