Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WERE Ave -3"'FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Z��Yzk le <br /> CITY/ZIP <br /> CROSS STREET APN -2—T 2C —170—'tS PARCEL SIZE <br /> OWNER NAMETl/ PHONE <br /> M OWNER ADDRESS ��_�/ /7/ •� _ _ CITY/STATEIZIP <br /> CONTRACTOR 4 ,Z, PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE C-42 Q C-36 OTHER NUMBER T EXPIRATION DATE <br /> WATER TABG DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#��OO !�U!_>—LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE! <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE; ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: r rtn rt MB PhO EES:, <br />' SEPTIC TANK TYPE/MFG �cI<- �-/ CAPACIT al PA <br /> ❑ GREASE TRAP TYPE/MPG • CAPACITY. l #OF P/RTM <br /> E I gd% 11 <br /> g% <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION c ROPER�.Y yNE pecte ft <br /> Hvd❑ LIFT STATION SIZE TYPE OF PUMPbit❑- SAN OIL SEPARATOR.(ENGLOSEDMTEM) <br /> I J <br /> ❑ LEACH LINES I LEACHING CHAMBERS_ //�1 / /h� #OF LINES ^ LENGTH OF LINES�/ tt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL t`1 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 />( Q DISPOSAL PONDS WIDTH ft LENGTH - ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft. <br /> DISTANCE TO NEAREST WELL I t FOUNDATION ft PROPERTY LINE ft <br /> YY� <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY yr <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ) <br /> /MINIMUM OUR D NCE NOT[C EQUIRED FOR INSPECTIONS-PLEASE CALL(209)453-7647 <br /> SIGNED U/ v� 1 TITL v f DATE <br /> I <br /> ° EV <br /> 1 � <br /> i. <br /> 1 � <br /> DETAINWAEI TA L <br /> I <br /> 1 <br /> G <br /> F , <br /> ORTMENTe-%UJSE-Q LY Jp ccepted Ey Date -3 7 ` Area +� Employee ID# ! 1� <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS c hof - -�u�►• Z -� 5 <br /> �Z G `F as c <br /> e it s !Yc� <br /> PE 11V ceived heck# Aouat Permit/ 5'` <br /> Date Invoice# Permit ID# <br /> Code INFO B Remitted Service Re,uest# <br /> Z.13 117 3 zO ao 3 DSP P0 `hs <br /> ONSITE WASTEWATER PERMIT <br />