Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 963-7697 FOR INSPECTIONS C EXPIRES 7 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIIPnP <br /> CROSS STREET APPIN V PARCEL SIZE O <br /> OWNERNAME f(Iibftk-'� PHONE v <br /> OWNER ADDRESS -- CITY/STATE P 2'/ C <br /> CONTRACTOR��d6-Z- L�i� ���/IC,�-.} 9 Q NE 2.65 I Z- J Q�7yyy����7So <br /> CONTRACTOR ADDRESS I Z��I^GG ff �Rf// JcrJ CITY/STATE/ZIP �/� ,C� C'Fi <br /> LICENSE UC-42 4C•36 OTHER NUMBER`E}==?(`'-`�`-�EXPIRATON DATE__1'4 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ 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 "PC # <br /> CAPACITY gal #OF COMPARTMENTS <br /> ►'� <br /> Fn, <br /> E WE __ fl FOUNDATION ft PROPERTY LINE ft <br /> CTI TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR <br /> P _ ...... <br /> r� <br /> {!^ ttL ylf �G❑'rL�SC CHAMB;P$ #OF LINES LENGTH OF LINES It <br /> ^ , <br /> "-W�L fl FOUNDATION ft PROPERTYLINE fl <br /> 11uj LENGTH ft DEPTH fl <br /> ��i� wenta1� L ft FOUNDATION ft PROPERTY LINE It <br /> byWIDTH ft LENGTH fl DEPTH fl <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE fl <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE ft <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 /> I R A VA TICE REQUIRED FOR INSPECTIONS-PLEA)SE CALL( 09)953-7697 <br /> SIGNED TITLE % �". DATE <br /> i <br /> PAYMENT <br /> RECEIVED <br /> N 2 6 2012 <br /> JOAQUIN CMNTY <br /> E W RON MENTAL <br /> TH DEPARTMENT <br /> �� DEPARTMENT"T—ONLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PE MIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> CO MENTS �Q� \'S <br /> 7 19, gr�Y • C�n.n�i.�, �d o Gam' <br /> CJS rte, <br /> PE SC Received Cunt <br /> Amount Date _ Permit/ u Invoice# Permit ID# <br /> Code INFO B Cash Remitted <br /> 42-01 <br /> 22 r l�n�✓l _•oc) i � � ;� <br /> Lew i S}'� � f.� <br /> �V' ,� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />