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 209 953-7697 OR INSPECTIONS EXPIRES 1 Y FROM DATE ISSUED <br /> JOB ADDRESS CITYt21P <br /> CROSS STREET AP hIJ '��O D- i� PARCEL SIZE �� y <br /> is <br /> OWNER NAME PHON 1 " <br /> OWNER ADDRESS CrIY/STATE21P <br /> CONTRACTOR AeRV PHONE IMPR <br /> CONTRACTOR ADDRESS /� ^ I '�CrIYY/STATE/ZIP <br /> LICENSE C-42 C-36 OTHER NUMBER`�T^�1�@$�_ATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> '..' PERC TEST # BUILDING PERMIT# LAND USE APPLICA ON# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION NGINEER DES NED ALTER T <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTIO <br /> INSTALLATION WILL SERVE: ' RESIDENCE I i COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL ft FOUNDATION h PROPERTY LINE ft <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 ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE K <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH tt <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH h <br /> DISTANCE TO NEAREST WELL II FOUNDATION It PROPERTY LINE fl <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft 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 /> MINIM UR A O ICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-76 7 <br /> SIGNED TITLE �+ ^(� DATE <br /> PA <br /> ;9.FIARTMEN-1 IlSE NL <br /> Application Accepted B{x,� Date Area mployee ID# <br /> Final Inspection By I 1• "� ate SPECI L PERMIT-Approved by <br /> Character of Soil th of Ft: Pit/ ump Soil Char cter: I' , �+ <br /> COMMENTS y � ���QU' ���U <br /> -- ... -- -I RON N COVN <br /> ry <br /> PE SC Received eck Amount Permit/ <br /> Code INFO By Cash lVmitted Date Service Re nest# Invoice# Permit ID# <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 411-'/18 <br />