Laserfiche WebLink
ONSITE WASTE` ',TER TRC-�/'1EATMENT SYSTEII� ERMIT <br /> SAN JOAQUIN COUNTY ENVIRONM RAL HKALTII DEPN�T �aJV - rod 304EWF:BERAVE -31.-STOCKTON CA 95202 - (209)46B-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> N <br /> JOE ADDRESS Z�J CITY/ZIP <br /> �j�)9n � <br /> CROSS STREET I-F-f�N� I APN 000 "O� PARCEL SIZE <br /> OWNER NAME LIQ/ y4 r""1'-r, mLL-,Sy /V7 rIWS��-� / `Z� ^ C��L� PHONE 7 <br /> OWNER ADDRESS a"1 (I PN <br /> Y/�LUI�n) 1 /G� AC0ICJ "/ ;JQZ 1 Y/STATWZIP \� f LT��j- � 5­7'5- <br /> OWNER <br /> � <br /> CONTRACTOR ^�-t/,)F(L-t--O'L� PHONE _,1�T D G /F��^�/�J, <br /> CONTRACFOR ADDRESS -97y �,� YVN LSV — CITVISTATE/ZIP 57r7eAj / 7 L�/J <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y , 1Y <br /> PERC TEST(S) NUMBER LAND USE APPLICATION# v <br /> TYPEOFWORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ .REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING 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 /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION 11 PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) tggqq^ <br /> ❑ LEACH LINES ❑ LEACHIN HA R #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NE ELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH H LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION 11 PROPERTY LINE Il <br /> ❑ MOUNDED WIDTH Il Li;NOI'11 11 Del''1'I1 11 <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <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 R FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIPY AT 1 HAVE PREP4w THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> 77gSTAT WSAND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> U OU A ANTE NOTICE REQUIRED FOR INSPECTIONS-PLEASE.CALL(209)953.7697 <br /> SIGNED TITLE DATE <br /> DATE IO Zv Oj <br /> I LL <br /> Off <br /> FAJ <br /> t ` <br /> � 1 <br /> • �- UB IC <br /> FNA( IFAf HLIVIS N <br /> TEL <br /> DEPARTMENT USE NLY --YY <br /> Application Accepled Cl Area /7- Employee ID# - 34C Y�C <br /> Final Inspection Date / ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS �tztzn <br /> PE SC Received bee Amount Date Perm 11 Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-01-001 <br /> ONSITE WASTEWATER PERMIT <br /> 12/2/02 <br />