Laserfiche WebLink
33a ONSITE WAS 7,WATER TREATMENT SYS '"' NVI PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH ;kRTMENT 304 E WEBER. -3""FL-STOCKTON CA 95262 - (209)468-3420 <br /> j <br /> NON-REFUNDABLE <br /> �PERMIT -CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ` I �GZ- �.�—_ !TY <br /> /ZIP •-C� r5� / S <br /> CROSS STREETAPN Y PARC E 0 <br /> r©c -12d --�� <br /> C <br /> OWNER NAME Je�'G L 2— Z [) 1-7 co PHONE <br /> (n) [D) <br /> OWNER ADDRESS - / _ _ CITY/STATE/ZIP <br /> CONTRACTOR L 00 J <br /> PHONE p L <br /> CONTR �ACTOR ADDRESS Z:ZAl, �QC� ` CITY/STATE/ZIP� �CL r. ` 2- / S <br /> LICENSE ❑C-42 ;&C-36 OTHER---&--- Z �4 <br /> NUMBERz / EXPIRATION DATE 2 a e S� <br /> WATER TABLE DEPTH; ft GEOGRAPHICAL INFORMATION: Coordinates X y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# —� 1 <br /> TYPE OF WORK: ❑ NEW INSTALLATION Q 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 C� CAPACITY Z-0 tJ � gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG ' CAPACITY <br /> gal #OF COMPARTMENTS <br /> G <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY�btNE ft <br /> ❑ LIFT 5:TATION SIZE TYPE OF PUMP £❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) _ <br /> LEACH LINES ❑ LEACHING CHAMBERS #.OF LINES � LENGTH OF LINES � }2 <br /> E+ <br /> A DISTANCE TO NEAREST WELL I ft FOUNDATION ift PROPERTY LINE t1 <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE t3 <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft E <br /> Cl SUMPS WIDTH ft LENGTH ft DEPTH }j <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 FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH 3 ft LENGTH ft DEPTH 2 S` ft <br /> DISTANC$TO NEAREST /'{?.WELL /S c�- ft 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 /> M1N1 M 24 HO R ADVANCEINOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE 41-"7L <br /> 7 p-za JDATE <br /> �. <br /> i/ PAY <br /> AYLL <br /> 4 .7 <br /> iV a <br /> /. �. � �.. L:%` NORTH $A� ''•` <br /> r/ PROP09tp 16&9 94,WNGL8 <br /> 102/ <br /> At <br /> 04 <br /> T U lr+ —. <br /> Mxl LOYxttY+P <br /> _ lVE p1T.WT Ml <br /> .rued ww.ra:uexura- <br /> w r u yv <br /> /Y- <br /> LAI 1 <br /> Or tt <br /> w I-! OD - <br /> J:j <br /> �-:. _ - - -. �r�-mac;=.�`-r'��z•--r.�-"'.'-iYEPAi�'L'IPI�`.R'I`tt1S`'E'[�L.l'..�r�-""-x'.. -.. _ -.��.-7e� -�ars...�_�._�..�-.t.„�.,�-.._r �- <br /> Application Accepted By Date 11L Area Employee ID# <br /> Final Inspection By / Date ❑ SPECIAL PERMIT-A <br /> El � pproved 5y <br /> Character of Soil to Depth f 3 Ft: Pit/Sump Sail Character: <br /> COMMENTS5 � <br /> !l S r <br /> Ei <br /> PE SC Received heck#/ Amount Date Permit/ <br /> Code. INFO B as Remitted Service Request# Invoice# Permit ID# <br /> El <br /> ��""`�/L.�� � E������'rL�!'te�1''� ��✓Y�J�✓J�� �� ��'"�+�JRiB�E WASTEWATER PERMIT <br /> lG��.... .'r. . � r,�,r.—r�..l�ti�r.► .G1��.Q�... ..- w i.... � r ..rte ..r .—. -. - - <br />