Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 304 E WEBER AVE -3"FL-STOCKTON CA 95202 - (209)468- <br />` t-AN JOAO UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> NON-REFUNDABLE PERMIT CALL(209)953-707 FOR INSPECTIONS EXPIRES I YEAR FROM DATA IS <br /> III, ICITY/ZIP dl "� <br /> a <br /> OB ADDRESS <br /> J APN_ n ` I(LV �/� PARCEL SIZE tz <br /> CROSS STREET ~—� <br /> PHONE <br /> WNER NAME C r Z 3�� <br /> ,Q v CITYISTATE/ZIP(J <br /> -JWNERADDRESS <br /> PHONE <br /> -ON TRACTOR <br /> CITY/STATEIZIP <br /> -ONTRACTOR ADDRESS <br /> �WA�TERTABLE <br /> NUMBER EXPIRATION DATE Q <br /> ❑C-42 ❑C-36 OTHER Y <br /> DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> L NUMBER LAND USE APPLICATION# <br /> -0 FERC TEST(S) 0 ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPAIRIADDITION <br /> TYPE OF WORK: NEW INSTALLATION 0 DESTRUCTION <br /> ❑ REPLACEMENT <br /> ,€ ❑ COMMERCIAL ❑ OTHER <br /> -INSTALLATION WILL SERVE: RESIDENCE NUMBER OF EMPLOYEES: <br /> NUMBER OF LIVING UNITS: N UMBER OF BEDROOMS: <br /> I q\ <br /> CAPACITY v gal #OF COMPARTMENTS <br /> SEPTiCTANK TYPEIHIFO�-z CAPACITY gel #OFCOMPARTMENTS <br /> i <br /> ❑ GREASE TRAP TYPEIMFG ft FOUNDATION ft PROPERTY LINE fro ft <br /> ❑ PKG TX PLANT DISTANCE To NEAREST: WELL <br /> � C� <br /> ❑ [3L[F1 STATION Slz£ TYPE OF PUMP eSAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> [�LEACH LINES ❑ LEACHING CHAMBERS <br /> #OF LINES t` LENGTH OF LINES <br /> f DISTANCE TO NEAREST WELL 1 01�ft FOUNDATION `� tL PROPERTY LINE <br /> f3 DEPTH ft <br /> ❑ FILTER BED WIDTH ft LENGTH tt <br /> 1! FOUNDATION ft PROPERTY LINE <br /> L DISTANCE TO NEAREST WELL <br /> F <br /> ft <br /> F R LENGTH ft DEPTH <br /> _.s❑ MOUNDED WIDTH ft PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> f; DEPTH ft <br /> ❑ SUMPS WIDTH ft LENGTH ft <br /> Fft FOUNDATION ft PROPERTY LINE <br /> DISTANCE TO NEAREST WELL ft <br /> ft LENGTH ft DEPTH <br /> ❑ DISPOSAL PONDS WIDTH fl PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL ft FOUNAATION <br /> If ft DEPTH_, ft <br /> i SEEPAGE PITS WIDTH LENGTH ' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARES THIS ATE LAWS CATION AND THE WORK WILL BE DNE AND REGULATIONS OF SAN A INCCOQUIN DANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> AND <br /> ES <br /> + MINIM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> TITLE DATE <br /> SIGNED <br /> r ' <br /> f � <br /> + Sr <br /> I <br /> 0 <br /> s , N <br /> N <br />