Laserfiche WebLink
f (-�JNSITE WASTEWATER TREATMEt :SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3""FL-STOCKTON CA 95262 -(209)468-3420 <br /> NON-REFUNDABLE 11 CALL(209)953-7697 FOR INSPECTIONS EXUMI R FROM DATE ISSUED <br /> JOB S CITVIZIP <br /> CROS EET / 472710//, APN �� / � 00 PARCELS(ZE -'�* <br /> QQ -- ( p <br /> OWNER NAME `D �. U te r r G P+HONF, A <br /> 7 ((�JFF((! <br /> OWNERADORESS - {�� ~2 O CITY/STATE/ZIP <br /> CONTRACTOR '`�^ �Gy l IPy1QJNE <br /> CONTRACTOR ADDRESS �Q F CA T"a(�Q l�I J CITY/STATEIZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> LLLWATER TABLE DEPTH; ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑'. PERC TEST(S) NUMBER LAND USE APPLICATION# 11 <br /> jp�"'^S TYPE OF WORK: NEW INS ALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 1 ; ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: / REsmexcE ❑ CpMMERC1OTHER <br /> NUMBER OF LIVING UNITS: 7 NUMBER OF BEDROOMS: �`--� .F NUMBER OF EMPLOYEES: <br /> + SEPTICTANK TYPE/MFG t�)PC4t-�LP �.- CAPACITY Oct gal #OFCOMPARTMENTS �-- <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY ] gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DIWANCETO NEAREST: WELL R FOUNDATIONr.Ifs ft PROPERTY LINE 6 fl <br /> r ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> FF 1 %J I <br /> L LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL_. loo_,-_-ft FOUNDATION w R PROPERTY LINE '15-0 ft <br /> ❑ FILTER BED WIDTH fl LENGTH ft DEPTH B <br /> Fil DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE❑. MOUNDED WmTH R LENGTH fl DEPTH fl <br /> _ DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE fl <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH It <br /> DISTANCE TO NEAVsT WELL R FOUNDATION ft PROPERTY LINT} R <br /> F SEEPAGE PITS WIDTH��ft LENGTA ftHft DEPTH it <br /> DISTANCE TO NEAREST WELL J V ft FOUNDATION ft PROPERTY LINE <br /> I HERE R> FY TH T I HAVE PREPARED THIS APPLICATIONAND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> C STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ( ; M MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)953-7497 <br /> JIET'I SIGNED TITLE L=�� DATE 42 [ 4 a3 <br /> r � <br /> =P, <br /> Ile <br /> �i <br /> �. <br /> t? <br /> I <br /> �i a <br /> k <br /> SkNJOA <br /> �] -EnIR N t 7A <br /> DEPARTMENT YSE O ' Y ) <br /> �^+ ^'�.�--'Date <br /> Application Accepted By 7 �— Cll_ Area Employee ID# <br /> Final Inspection By Date © SPECIAL PERMIT-Approved by (� <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS A-6 S r Q on)r''eTUrf7 �r�' DSne� a3�} S 5� <br /> lot C <br /> i <br /> PE SC Received IC <br /> K/€! Amount ate - Permit! Invoice PermitlD# <br /> Code INFO B Remitted Service Request# <br /> ( C _ 3a J � / 5 ---3(cb7 77 7 <br /> --# 1 <br /> 42-0I 001 <br /> ONSITE WASTEWATER PERMIT <br />