Laserfiche WebLink
ONSITE WAS._.- ,WATER TREATMENT SYS' 4 PERM_ IT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209053-7697 FOR INS ECTIONS EXPIRES I YEAR FROM DATE <br /> j ISSUED <br /> JOB ADDRESS ORLCITY/Yr//ZIIPP/�} cle.I17e,44.f 2X24--� y <br /> CROSS STREET' d APN �• /"V �+v`� PARCEL SIZE p <br /> r OWNER NAME �ep >_<. I- PHONE <br /> !! OWNERADDRESS CITYISTATE/ZIP <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS e CITY/STATEIZIP <br /> LICENSE C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE Sf <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X. Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT Li DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> // <br /> ❑- SEPTIC TANK TYPE/MFG LoRelreA CARACITY 1,600 gal #OFCOMPARTMENTS 4*X 5*1 <br /> ❑ - GREASE TRAP TYPF/MFG CAPACITY gal #OF COMPARTMENTS i , <br /> ,f <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL f OO ft FOUNDATION� R PROPERTY LINE �' ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Ise LEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES �Q` ft <br /> DISTANCE TO NEAREST WELL �© � ft FOUNDATION ft PROPERTY LINE r ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> © MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 11 <br /> SEEPAGE PITS NUMBER 1 WIDTH ft DEPTH s��� ft <br /> DISTANCE TO NEAREST WELL 160�ft FOUNDATION ft PROPERTY LINE °LG ft <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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS--PLEASE CALL(209)953-7697 e� <br /> SIGNED TITLE C.�t, %a c DATE is&L- <br /> -A <br /> M <br /> fffo <br /> r <br /> I <br /> D <br /> i <br /> DEPARTMENT USE, .NL .. . . <br /> Application Accepted By Date ' ©J®' Area x.,Employee ID# <br /> Final Inspection By Date /C �Q�❑ SPECIAL PERMIT-Approved by '� r <br /> Character of Soil to Depth G(3 Ft: Pit/Sump Sol aracter:_ � r�_ <br /> COMMENTS ' -P d F E rL <br /> PE SC Received k#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B h Remitted Service Request# <br /> v S'� 2- O Ligo f Y <br /> 42-02-001 ONSIT WASTEWATER PERMIT <br /> 12/22/2003 I X V <br />