Laserfiche WebLink
�d <br /> ONSITE WAS1�'VATER TREATMENT SYSTE)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 l YEA FROM DATE ISSUED <br /> It JOB ADDRESS CITY/ZIP <br /> f x � <br /> CROSS STREET `� 'P APN 4V/—��y �O/ PARCEEL SIZE l Z[J� ac d <br /> OWNER NAME �Oc J/• {�iZ� PHONE <br /> OWNER ADDRESS �� �/ /►' D CITY/STATE/ZIP_ <br /> CONTRACTOR PHONE <br /> PHONE O 6'/Fk <br /> CONTRACTOR ADDRESS Z7 CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION; Coordinates X <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# q 04-130/ <br /> TYPE OF WORK: ❑ r NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LI VING-UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) G <br /> f" <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LrNEs LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft C' <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO.NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> I <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft �) j <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH R <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 g <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY: (p <br /> NIMUM 2OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASF CAfL1L(209)953-7697 <br /> SIGNED `� TITLE DATE <br /> N <br /> e <br /> oou xarfVaulu — � .: <br /> AYM JO 1xOxl�V ——— ----.....r...--.——__5��������_—_��� -.. ..e -_ ._... <br /> OOIq—MLOp 9 1M2 TCS GAY 1 W ' <br /> 4"x1�•Oe..I'4° Z�3SYd ' � g ,Y <br /> s_ <br /> SMON _ g <br /> Y�J I 13 a HfrA <br /> fir--.r N� g r <br /> oxeax ro oe..rar .. <br /> .. 'ill ICA�YM1lli SCf .. <br /> � 1 <br /> DEPARTMENT U ENLY `C <br /> Application Accepted By Date .�! OS Area Employee[D# <br /> Final Inspection By Date 417 '�. ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PIUSump Soil Character: <br /> COMMENTS <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Cade INFO By ash Remitted Service Request# <br /> 42-02-001 ONSITE WASTEWATER PERMIT 1 <br /> 12/2212003 <br />