Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT -) y 0-7- <br /> SANJOAQUIN OUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3"FL-STOCKTON CA 95202 - (309)41/663/20 <br /> BIR NON-REFU DABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> yJ1`WO,IB_ADDRESS '1 57,� CITVIZIP &CIR N'V <br /> ` Sv 0N UVGGY� • d'or P RCEL SIZE 3 <br /> ROSSSTREET �.!•iy • .,3 A/,PN 7^�NO <br /> -07 <br /> SR, ONNER N'AMf V` TP p` ��� �3 'p/V�� - i- QL PN'O/N''E //�/y1 (j/ 'J <br /> ONNERADDRESS I j0 31 .N, SG c k TG is— `Q CIT1'ISTATEIZIP �QV4 l ' /1 `I//.qO <br /> CONTRACTOR PHONE V I <br /> BER <br /> CONTRACTORIADDRESS CITY/STATEIZIP <br /> LICENSE LJC42 LJ C-36 OTHER NUMBER EXPIRATION DATE <br /> WATERTABLEDEPTH: R GEOGRAPHICALINFORMATION: CDordlnaleE R V <br /> tp PERC TEST M BUILDINGPERMITO LAND USE APPLICATIONN <br /> TYPE OFWORK: ❑ NEW INSTALLATION ❑ REPAIWADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRLrM" \ <br /> INSTALLATION WILL SERVE: 13RESIDENCE L3COMMERCIAL LIOTHER LI <br /> ` <br /> NUMB E OFLIVINGUNITS: NUMBER OF BEDROOMS: NL'MBEROFEMPLOYEES: <br /> ❑ SEPTIC1(TANK TYPE/MPG CAPACT' SAI 00FCOMPARTMENTS <br /> L3GREAS6 TRAP TYPE/MFG CAPACITY SOI #OFCOMPARTME67S <br /> ❑ PKGTKPLANT DISTANCETONEAREST: WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT S'II TION SIzE TYPEOPPv.P ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINEs LENGTHOFLINES ft <br /> R. DIWANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTERS BED W.. It LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH 0 LENGTH R DEPTH It <br /> LII DISTANCETONEAREST WELL R FOUNDATION (t PROPERTY LINE R <br /> ❑ <br /> SUMPS <br /> WIDTH ft LENGTH ft DEPTN ft <br /> IIA DIBTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSI LPONDS WIDTx fl LENGTH R DEPTH p <br /> ` DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> LJ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> LY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ' <br /> MINIMUM 24 HOUR ADN'AN'CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)951-7197 <br /> SIGNED TITLE Co•..�S y.Mw,.T DATE <br /> V <br /> W <br /> P�PN. <br /> G <br /> a <br /> L - <br /> 14- s <br /> L <br /> L <br /> I 1 1P <br /> L .. -� 1. <br /> ` ! EPARTMENT Lr E Op' (///!� <br /> Applintlon AtceP3 Date Area Employee IDM _,. <br /> Fl w Inspectibn BJ N. ❑ SPECIAL PERMIT-Approved by <br /> ChvrRcler aims In 9T3 Ft: PIU ump Soil Chvrvcter: <br /> V COMMENTS <br /> ISO <br /> �t U-P/.% i� .. _ 7 , .✓ 5 k.. \ '�1 C•'c/mss <br /> PESC Reeelvetl ChSpYM Amount PermiU <br /> Cotle 1". By Cvsh Remitted Mte Servlee Request Invoicep PermillDN �.- <br /> Q3 71 > .00 / , 7CO 5 1; .-71 <br /> L 42-022X)1 i`.�� C• " °•'2 orA� `3c (•rO�1J j lMr•/1./. � - 7- IR-Q� ONSITE WASTEWATER PERMIT <br /> 1223203 cT�s <br /> •.� da_+ -LJi Pc._n L zC.-•I m.... \'1G .waive.., A. I AHf.Q <br />