Laserfiche WebLink
7,0 <br /> ONSITE WASWATER TREATMENT SYST^M PERMIT <br /> SAN JOAQUIN COUNTY ENV IRONMENTAL HEALTH D... �RTMENT 304E WEBER A.y 4-3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIR`E,St�I YEAR FROM DATE ISSUED <br /> JOB ADDRESS r !- -(A) 2�$ CITIV//z1P /n [r�/ /� �q jam/ L <br /> CROSS STREET E�'�"7/�7 APN .- V" 4+� PARCEL SIZE C:?-/J o <br /> y 66 <br /> OWNER NAME �GQ PHONE <br /> OWNER ADDRESS <br /> f CITY/STATEIZIP <br /> CONTRACTOR A �V1 � 7/ <br /> PHONE <br /> CONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y /V�7 <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DES]GNED(ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> Iz— <br /> E , NUMBER OFLiv INGUNITS: NUMBER OF BEDROOMS: NUMBEROFEMPLOY$ES: <br />[ `L{d�EP.TIC TANK TYPE/MFG CAPACITY— W1PP��O gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS [\\ <br /> ❑ PKG TX PLANT. DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ,LVA <br /> pLIFT STATION SIZE TYPE OF PUMP E) SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Slid/ IN ❑LEACH LES LEACHING CHAMBERS #OF LINES �LENGTH OF LINES U tt <br /> DISTANCE TO NEAREST WELL � ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WWTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 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 /> MINIM M 14 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> /-PLEASE CALL(209}953-7697 { <br /> SIGNED / G�� TITLE W DATE 1 �� <br /> L nil <br /> e <br /> E <br /> N <br /> _M <br /> QVIE <br /> IrlaT r..n�l! I <br /> DEPARTMENT US ONLY <br /> Application Accepted By Date (09/f ,-6,3__ Area I�o Employee I D# <br /> Final Inspection By fj i[%�r /�i�— Date 614 z-10 7 11SPECIAL PERMIT-Approved by <br /> It Character of Soil to Ddpth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS 013 k �15ch 1 �4 41`—` c <br /> !2-, <br /> PE Sc Received Check# Amount Permit! <br /> Code INFO B ash Remitted Date Service Request# Invoice# Permit ID# <br /> 1 <br /> I �z <br /> 42.01.00] io <br /> 1212101 —. — ONSITE WASTEWATER PERMIT <br />