Laserfiche WebLink
J ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQL'IN CODNFY ENVIRONMENTAL HEALTH DEPARTMENT 1W EWEBER AVE-3'°FL-STOCKTON CA 95301 -G")e 21420 <br /> NON-REFUNDABLE PERMIT CALL(202 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JORADDRESS ����f� CIT/rvi�v, e'1 [� <br /> CR06.9 STREET yS/I\V/\1IAAXl*]lfL' ,,� T C] ��/•1. �APN 1 �,-�VL�' L T PA cELSIEE /275 <br /> OWNER NAMEL I11�IW) I Lam' t�I IV^N, BVI I,,LJl ix...///J���111.EL.C,z/ PNON I J/YI <br /> OWNERADDRESS -. {V L -ecylu U "' CITV/SYATIJ%1! <br /> CONTRACTORQ%Mlfi-- PHONE <br /> CONTRACTOR ADDRESS CETY/$TATiIZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER ERFlRATN]N DATE <br /> WATER TABU..DEETN: /C- JS 0 GEOGRAPNICALINFORMATON: CDOMIOMO % Y <br /> ❑ PERC TEST N BUILDING PERMIT# 0 U H LAND USE APPLICATION# <br /> TYPE OF WORK: NEWINSTALLATION ❑ REPMdADDMION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: REMDENCE ❑ COMMERCIAL ❑ OTHER 1 <br /> NUMDER OP LIVING UNm NUMELROFBE.MMS: NUMBEROPEMMAVEES: V <br /> SEPTIC TANK TYPE/MFGCAPAC Bal NOFCOMPARTMENTS� <br /> ElGREASE TRAP TYPFJMPO CAPAC r ®I NOFCOMPARTMENTS <br /> ❑ PEG TX PLANT DISTANCETONEARF31': WELL R FOUNDATION D PROPERTY LINE ft ! <br /> ❑ LIFT STATION SITE TYPEOPPUMP O SA LSEPARATOR(E•Vc <br /> 67'• LEACH LINES ❑ LEACHING CHAMBERS N OF LNESNDm DF LIrvEft <br /> /V DISTANCE TO NEAREST WELL /d o A FOUNDATION ft PROPERTT s LI E R <br /> ❑ FILTER BED WIDTH R IEWTx R DEPTH R <br /> DLYEANCE TO NEAREST WELL _R FOUNDATION R PRWERTY LNE ft <br /> O MOUNDED WIDTx fl LENGTH ft DEPTH fl <br /> DISTANCETONWRESE WELL It POUNDATON R PB01ENTY LINE fl <br /> ❑ SUMPS Winn ft LENGTH ft DEPTH fl <br /> DISTANCETONEARESI' WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS Wim-ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREAT WELL It PWNDATON It PROPERTY LME A <br /> ❑ SEEPAGE PITS NUMlER-WHn" R DEPTH It <br /> DISTANCEMNEARM WELL ft FOUNDATION ft PROPERTY LINE R <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 /> M INH MU M: UR �REQUI RED FOR I NSPF.CTIONS-PLEASE CALL 1309)931-7697 <br /> SIGNED TITLE DATEb <br /> IN <br /> g 5 ,r N <br /> r � <br /> IS r <br /> � too? <br /> M � I <br /> It <br /> a <br /> AppllprloB A pmE By DMr 6 Arca Empbym IDN 737 J 3�yq <br /> BRaI IMpeetbD By Date ❑ SPECIAL PERMIT-Approved by <br /> Charterer of Soil to h of J F: PI mp Soll chm.wIe. <br /> COMMENTS - <br /> PE SC KeeelVeO Amaoat Date Per.lu IDvokeN remitlDN <br /> Cat# Ineo aM RemUMtl n Service <br /> lRequest 0 ry. <br /> eJ-01-001 ONSITE WASTEWATER PERMIT <br /> 1T2LT0E] <br />