Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3 R FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE <br /> J/ diJ7 <br /> PERMIT e CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROOM DATE ISSUED <br /> / <br /> JOB ADDRESS f 9 3 v0z4 CITY/ZIPrQC�-'©AI v/-SZ� <br /> CROSS STREET •���e E APN /D3 Z 13 PARCEL SIZE <br /> O °v <br /> OWNER NAME PHONE <br /> OWNER ADDRESS �� CITY/STATE/ZIP <br /> CONTRACTOR L t PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP 1 <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# V� <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 Z-VA",egry-jr ISwEEy CAPACITY J(PAp gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> � 1 <br /> LlPKG TX PLANT DISTANCE TO NEAREST: WELL �® ft FOUNDATION -20' ft PROPERTY LINE9Q ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i <br /> ❑ LEACH LINES A LEACHING CHAMBERS #OF LINES 3 LENGTH of LINES ft <br /> DISTANCE TO NEAREST WELL 7O ft FOUNDATION PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH $ <br /> DISTANCE TO NEAREST WELL ft 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 /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATIONft PROPERTY LINE R <br /> A SEEPAGE PITS NUMBER -3 ,WIDTH � 4-zt, ft DEPTH �-SI ft <br /> DISTANCE TO NEAREST WELL /:F00 ft FOUNDATION gQ t 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 <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED '4ZQ"'.�OrTITLE G�G�t!T/2Af�O/1 DATEsf9/�4a <br /> P` <br /> qt I <br /> 444 <br /> 31 <br /> NI <br /> yul <br /> r <br /> 7 <br /> -i <br /> 3 <br /> f L <br /> J h, i'J A <br /> LT D-F RT F T <br /> y f <br /> tt— <br /> 7+ <br /> DEPARTMENT U E O /� <br /> Application Accepted By �. Date q Area Employee ID#��3-�y�/-/- (q <br /> Final Inspection By Date_k � C' - ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: Pit smrip Soil Character: <br /> COMMENTS &k�W ,�.� CIF (Z���'- 'V-my --w4/—T� Nl'g2we.2 &Amtv ags, art <br /> V&ir-_ TSI Ci01?T �AttZ L.T E edj �,� � J�ts a S r J0 %C; Mi/�- <br /> �� /F,..h�,rz s, ..�.. � yzcc'� <br /> tiP t uc.ie 4 D& - c <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B C sgTi-7 Remitted Service Request# <br /> �I ( E w--- c` 5 % C 2 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />