Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAO=COMM JEWROMMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> Joa ADDRESS 367j. CITyap f%, - 'A <br /> CROSS STREET '07 <br /> APH <br /> OWNER NAME UPHONE -9 3C r� k 9(1 a <br /> py\ <br /> OWNER ADDRESS 3 Q, CrTYISTATErLF <br /> CONTRACTOR 11 yyp'Ai I <br /> PHONE ------- <br /> CowmAcmADDRESS (v CffVr1STATerZIP V <br /> LICENSE QC-42 QC-38 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GaOrRAPHCALINFORMATION; C00rdin8t0t X y <br /> I-A—PERCTIEST # BUILDING PERMIT# LAND USE APPLICATION# 0(4 0 TA <br /> TYPE OF WORK: 0 New INSTALLATION 0 REPAiRIADDITION 0 ENGINSEADIESIGNED/A <br /> U REPLACEMENT 13 DESTRUCTION <br /> INSTALLATION WILL SERVE: n REsioENm 0 COMMERCIAL D OTHER <br /> NUMBER OF LPAKO UNITS: NUMBER OF BEDROOMS: NUM13EROF:EMPLOYEES. <br /> 13 SEPTIC TANK T)rPEIMFG CAPACITY_ gal #opCOMPARTMENTS <br /> — <br /> U GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST., WELL ft FOuNbAnON fl PROPERTY LINE—ft V� <br /> E3 LIFT STATION SIZE TYPE OF PUMP —0 PKG TX PLANT 0'SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> CI LEACH LINES 0 LEACHING CHAMBERS #oFLINES _ LENGTH OF LINES it <br /> DISTANCE To NEAREST WELL it FOUNDATION_It PROPERTY LINE it <br /> 13 FILTER BED WIDTH It LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL_it FOUNDATION It PROPERTY LINE ft <br /> 13 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL_it FOUNDATION It PROPERTY LINE ft <br /> El SUMPS War" H LENGTH It DEPTH <br /> DISTANCE To NEAREST WELL_it FOUNDATION R PROPERTY LINE <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST' WELL_ft FOUNDATION ft PROPERTY LINE ft .1y <br /> L1 SEEPAGE PITS NU&MER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 4 FOUNDATION ft PROPERTY LINE it <br /> L HERESY CERTJFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK VM.L BE DONE IN Accowmcii wrFm SAN jomauw COUNTY ORDINANCES. <br /> 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 i A 1� Tnu DATE <br /> q jt- <br /> I f )41"11 kk -1I % <br /> 0,qEtI <br /> 4X1, <br /> 121- <br /> 7 <br /> '' €Arvr <br /> 7 <br /> DEPARTMENT U!ON Y <br /> Application Accepted By <br /> Date_/J2, f Area Employee]DO <br /> Final Inspection By on" n SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PIUSwnp"I Character: <br /> COMMENTS <br /> PE SC Received ChecW' Amount Data P021,u..t 0 Invoice# Permit IDN <br /> Code Iwo By Mh Remitted _sr,. <br /> 44,;1.'2 h) <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />