Laserfiche WebLink
r•� <br /> ONSHE WAS u UVA, Eft TREA, T IIMEN,9T SYSTEM EM PERI vIiF <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIOMS EXPIRES R YEAR FROM DATE ISSUED <br /> JOB ADDRESS 14/05-57r VA G PIC a CITY/ZIP TR AGt/ 9S?7G v' <br /> ,1 hi <br /> CROSS STREET C ` L 0 k. APN_ 2 — 49 - Q� PARCEL SIZE D•5-A y>yy <br /> OWNER NAME 1)9 . Fy 4,4 PHONE 'S I d f� B lo vh <br /> OWNER ADDRESS //957-/ W-L T VA L PI G fJ _ CITY/STATE/ZIP T/,<7,4j�V t4A 74 <br /> CONTRACTOR D o,`/,v(� /�S ?,C PHONE_a 0 AO 2 49:;5 z <br /> CONTRACTOR ADDRESS P p 6O SC �j7�'� CITY/STATE/ZIP ^r!/ZLOLI! GA 9S�Sl <br /> LICENSE 110C-42 ❑Ll -3G OTHER IZGG NUMBER S 7 EXPIRATION DATE 6--i0-11 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> FERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: LI NEW INSTALLATION ❑ REPAIR/ADDITION u ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ 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 /> Q GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Cl LIFT STATION SIZE TYPE OF PUMP © PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _ft <br /> 0 FILTER BED WIDTH ft LENGTH ft DEPTH � � ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY <br /> 0 MOUNDED WIDTH ft LENGTH ft DEPTH _ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT _ �J_ ____ ft <br /> C) SUMPS WIDTH ft LENGTH ft DEPTH `AN ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft -- PROPE) // UN�_ ft <br /> G9 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH THOEPAf3��N7, _ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE___- <br /> Q SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 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 /> EAL <br /> AD -IVCE iVO TICE REQUIRED FOR IAISPEPCDOMS - LEASE CALL 209 953-7697 <br /> SIGNED TITLC /Vic En/4i.yEE�P DATE e <br /> r � Av <br /> l64, s ` Io <br /> DA A R TM E NgTIU S E10 ALLY <br /> Application Accepted By 11 Date Area Employee ID#� <br /> Final Inspection By _ Date it <br /> ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to epth i:: _ i.LCiUFi Soil Character: <br /> COMMENTS rU � (� 2.1, g milt' .1?ry <br /> PE SC Received Amount Permit! <br /> Code INFO ash Remitted Date Service Request# Invoice# Permit ID# <br /> ?�i�� S N30S►2 oSS <br /> i <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />