Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3""FL-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDaFSS '%� '.7` � ` �' ^i. t' CITYIZIP '. •"�,r � 1.G'., >"�. <br /> CROSS STREET .'V( APN fYIF+ 'V L'C7 _ PARCEL SIZE !Y' <br /> OWNERNAME <br /> '~" 1 '�r ,.✓ I 111 J Y i,f=4 /!-/j PHONE <br /> - CITYISTATEIZIP <br /> y. OWNER ADDRESS f': "'- - - <br /> CONTRACTOR :. if ^' ei- PHONE <br /> i <br /> CONTRACTOR ADDRIESS 'j I I 'I.I,J CITYISTATElZIP J rCf : <br /> LICENSE LI C-42 ❑C-36 OTHER NOMRER EXPIRATION DATE <br /> WATER TABLE DEPTII: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 1 ❑ PERC TEST # 'L BUILDING PERMIT# LAND USE APPLICATION 0 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED(ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> �[[{ INSTALLATION WILL SERVE: ❑ RESIDENCE t ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPElMFG CAPACITY gal #OF COMPARTMENTS <br /> } ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> Q PKG TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION R PROPERTY LINE R <br /> �1[[ ❑ LIFT STATION SIZE TYPE OF PUMP Y Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> S4 <br /> �y ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES P <br /> DISTANCETO NEAREST WELL R FOUNDATION A PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH fI LENG7H It DEPTH ft <br /> DISTANCETO NEAREST WELL A FOUNDATION H PROPERTY LINE ft <br /> PPP ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATIDN ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH A <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> i ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NLMBEH WmTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> 1 HEREDY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL.HE DONE IN ACCORDANCE WITH SAN JOAQU IN COUNTY <br /> -.r ^ ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI, lN134HOHR AN .,NOTICE REQUIRED FOR INSPEC'T'IONS/-P E CA 1A,(209)451.7697} <br /> SIGNED TITLE ; ( r "_ DATE <br /> I 4 <br /> �i <br /> i <br /> IM LNI IFI,ITA <br /> H f IEF W M <br /> E NT <br /> NT <br /> DEPARTMENT USE 9NLV <br /> Application Accepted By� '� "'r..-`�`�"`�- Date Area Employee ID# f <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character, <br /> COMMENTS <br /> I � <br /> PE SC Received %ChecM— Amount Date Permiv Invoice# Permit IDM <br /> Code INFO 13Y Cash Remitted Service Request# <br /> Lq <br /> 4-• <br /> 42.OZ-001 ONSITE WASTEWATER PERMIT <br /> ' i7J22/21)63. <br />