Laserfiche WebLink
ONSITE WASTEWATER TREATMiA T 4h PERMIT 0-5 4?.2©,& <br /> SAN 1 -�rtt}titipc A ,:ENVIRONMENTAL HEALTH DEPARTMENT { 4 E WEBER AVE-3-FL-STOCKTON CA 95202 -(209)46&3420 <br /> , . <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS L-�GL�. CITY/ZIP :A <br /> CROSS STREET -v"M - - - APN 4L01 17" / 7 PARCELSIZE p <br /> 7 <br /> OWNER NAME "[ I..+' � � PHONE �n <br /> OWNER ADDRESS Lam— CITYISTATElZIP <br /> CONTRACTOR AIL S'dPHONE -6 1 <br /> ,S <br /> CONTRACTOR ADDRFSS CITYISTATEIZIP <br /> LICENSE OTHER NUMBER ENPIRATION DATE �} <br /> WATER TABLE DEPTH, GEOGRAPHICAL INFORMATION: Coordinates X V <br /> ❑ PERCTEST # BUILDING PERMIT# LAND[15EAPPLICATION# <br /> TYPE OF WORK: - NEWINSTALLATION Q REPAIRIADDITION ❑ ENGINEER DESIGNED 1ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 12KRESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> E NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEPm: <br /> SEPTIC TANK T -JON�^1'"Tt��, <br /> YPE/MFG ! 5i&)e ; CAPACITY / gal #OF COMPARTMENTS <br /> I ❑ GREASE TRAP TYPEIMFG CAPACITY [�Q gal #OFCOMPARTMENTS <br /> 0 PKG TX PLANT DtSTANCETO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE A;;�O 11 <br /> Q LIFT STATION a,SS�IZE TYPE OF PUMP /,_ - CJ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> "1 LEACH LINES e LEACHING CHAMBERS 15,ull /`'. #OFLINFS_ - LENGTH OF LINES ^y� ft <br /> DISTANCE TO NEAREST WELL /a tt FOUNDATIONS fl PROPERTY LINEy ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE A <br /> 13 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q SUMPS WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q DISPOSAL PONDS WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEARE9Tpj4-WELL ftFOUrA�W ft PROPERTY LINE <br /> ft <br /> .� SEEPAGE PITS NUMBER ,,,_WIDTH �7- ry R DEPTH a _ ft <br /> DISTANCETONEARESr WELL-I,<=ft FOUNDATION, f22 R PROPERTYLINE- . I-; ft <br />! I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INIMUM 24 URA VANC NOTICE REQUkRED+.FOR INSPECT NS-PLEASE CALL(209)953-7697 p. <br /> I <br /> SIGNED /� sdyfLl'ITLE DATE <br /> i <br /> Of <br /> I 1A <br /> I <br /> i <br /> t J / <br /> DEPARTMENT YSE ONLY S IVIVICN E d�! <br /> Application e f Date I Area µFpLTHQF^PPIAuFSyecID# <br /> Final Inspect / ' �•� Date c - �'�' ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth r 3 Pt•, r' Pit/Somp Soil Character: c - <br /> COMMENTS DLs3 :,?13- q ! a-1= aE- D�r®i%uCar�rA a . c 11.-7c J ar rC -.,, 7 <br /> _ !i .?f-fl <br /> C-7 V <br /> ;-C FT �4c/ <br /> PE SC Received Cbecidtl Amount Date Permit! voice# Pergti�[D# <br /> Code INFO B Remitted Service Re Best# Y i <br /> ON WASTEWATER PERMI" <br /> x �� d,V.!-- �'�''✓ .ems=�~.6 -, r-. ..;! <br />