Laserfiche WebLink
D <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SANJOAQUIN COUNTYENMRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205.6232-(209)468-MO <br /> NON-REFUNDABLE PERMIT CALL 209 963.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB AmitesB la D 2 CmQ-rziP "y. <br /> CROsSSTRser G �lY.� APN Z' I:i D d Q7 PARCELSIZE 4P b <br /> (�y 1 <br /> OWNER NAMG �-0J�Fi+r;�� PHONE —-- <br /> OWNER.ADDRE$ ( { <br /> a '( �--^' :,9 a CITY/STATWZIP <br /> .CONTRACTOR /4 r F1 Q1 PHONE <br /> NTQ A�' <br /> CORACTORADDRESS �rC�1 I P Cr"i.t ; RJ _CITYISTATE21P <br /> LICENSE OC-42 QC-36 OTHEi. A NUMBER`17� EXPMTiON DATE <br /> WATER TABLE DEPTH: It GEOGRAPfdCALINFORMATiON: Coordinates X Y <br /> ❑ PERCTEST # BUILDING PERMIT# t7. AND USE.APPLICATION# <br /> 11PE OF WORK: NEW INSTALLATION ❑ REPAIRIAODMON ❑ ENGINEER.uESIGN5viAL1ERNATIVE <br /> (3 REPLACEMENT 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: )-RESIDENCE ❑ COMMERCIAL 11OTHER <br /> NUh90CROFLIVINGUNITS: __/1 HU1413ER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TyPEIMFG ` CO-h. G. CAPACTTY tf hb+/Z&V gal #iOFCOMPARTMENTS <br /> • GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCETO NEAREST: WELL L60^C ft FOUNDATION -15- ft ?ROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP 13 PKG TX PLANT ❑ SAND OIL SEPARATOR{ENCLOSED SYSTEM) <br /> ❑ LEACI•I LINES ❑ LEACHING CHAMBERS #OF LINES. LENGTH OF LINES <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft, PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH 21 it LENGTH Z7 It DEPTH 42" It <br /> DISTANCE TO NEAREST WELLft FOUNDATION it PROPERTY LINE. ft <br /> ❑ MOUNDED WIDTH ft LENGTH it DEPTH It <br /> DISTANCETO NEAREST WELL R FOUNDATION It PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH _ It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTYUNE ^^ft <br /> ❑ DISPOSAL PONDS WIDtaft LENGTH it DEPTH tt <br /> DISTANCE TO NEAREST^ WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS. NUMBERWIDTH ft DEPTH It <br /> • �,_.-_- DISTANCE_IL NEAREST WELL _ it FOUNDATION. it PROPERTY LINE it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL 59 DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY'ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI UM NAO CE NOTICE REQUIRED FOR INSPECTIONS <br /> (-PLEASE ALL(2095953 7697 <br /> �846NED TITLE L 111,rv� i fyo. DATA If •2 <br /> AV <br /> r <br /> i <br /> V r <br /> e dab rc <br /> N U <br /> T <br /> DEPARTMENT ELY <br /> + Application Accep Date Z 2 Area _ Employee[D# L <br /> Final Inspectie Date !.3 ❑ SPECIAL PERNMT•Approved by <br /> ChamcWr of Soil o. epth ..Ft: P Sump Soil Character: <br /> COMMENITS <br /> PE SC RecarvecK AmountPermit! Invoice# permit ID# <br /> Code INFO B Cash emitted Date Serviee Re t0 <br /> 3. Z� <br /> • 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014107 - <br />