Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"D FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-776/97 FOR INSPECTIONS E IR l EAR FROM DATE ISSUED <br /> JOB ADDRESS '/N CITY/ZIP <br /> — -1 <br /> CROSS STREET Ra � rx APN � 0 PARCEL SIZE ` y <br /> v <br /> OWNER NAME r A C.rh rocs '6PHONE /1-) —z U <br /> OWNER ADDRESS �� � `l�10 -5 T CITY/STATE/ZIP '5i 0 e-IC,"J/0 A /S <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE r, <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 1� NUMBER OF EMPLOYEES: �� N <br /> ❑ SEPTIC TANK TYPE/MFG r CAPACITY V gal #OF COMPARTMENTS C1 r <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY` gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED <br /> /SYSTEM) <br /> 14 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES s- LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL 100 ft FOUNDATION_ft PROPERTY LINE �`� ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH f1 <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 /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDA'ION ft PROPERTY LINE ft <br /> EEPAGE PITS NUMBER 7?�p WIDTH 5 ft DEPTH 25- ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION770 ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI ' 24 HOUR AD ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE') Lj 1JVZ+y— DATEba <br /> i <br /> 1' <br /> I NT Elk <br /> I ZIPr <br /> 17 <br /> I LIP <br /> o � <br /> IR N E Tif <br /> IFTTJ <br /> H H EAR <br /> DEPARTMENT US ON <br /> Application Accepted Date Area _ Employee ID# <br /> Final Inspection B Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to e h of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS rj— <br /> a S <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted 'n Service Request# <br /> Lfn <br /> �c <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />