Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT IZr "/ " <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT y -r CALL 209 953-7697 FOR INSPECTIONS ,p EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ZT�70 ,V —Jhf+AN? CTCITY1ZIP AfCAVKPD IIS-2-7-0 <br /> 5'Ar—[_ '—' <br /> CROSS STREET J��'tt N T 1e--1> - APN V ^�6V PARCEL SIZE + .35'A•—• > <br /> OWNER NAME C ODY Deli YVNSt c'/ PHONE S -v <br /> OWNER ADDRESS `-O. 30)( 97-0 1-547.20 )4 SoL4) °5 /4TY/9ATZII C; T', CZ� vvl <br /> C'A elJ <br /> CONTRACTOR L "JE 4o-+ W <br /> GEoEANA <br /> VIADA)M(W T 'L PHONE a(Pi-o3-i-S-A <br /> CONTRACTOR ADDRESS ` T W• OAr— ST• CITY/STATE/ZIP LDDI C' ` C 2-40 <br /> LICENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # I BUILDING PERMIT# 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: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE_ It <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft 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 /> AMIINIM/ OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASECAALL(209)953-7697SIGNED /"/fCiC TITLE DATE <br /> EwEO <br /> 19 201a <br /> IN CO0NN <br /> O RONMEN�P�N.� <br /> `�N�EPARSM <br /> DEPARTMEN O L e <br /> Application Accepted B Date Ara Employee ID# <br /> Final Inspection By Date SPE IAL PERMIT-Approved by <br /> Character of Soil to pth f 3 t: Pit/Sump Soil Character: <br /> �07MENTS <br /> I t 7VI12 ky =A Sr- <br /> PE SC Received Check#/ Amount ate Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted �Service <br /> 7Re uest#T <br /> S' !% lJ <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />