Laserfiche WebLink
1(J/y E1 2(J r-7- <br /> I <br /> ONSITE WASTFTER TREATMENT SYSTEPERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPAn'i'AENT 304 E WEBER AVE---" STOCKTON CA 95202 - (209)46S-3420 '-- <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS //EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS _�7��C� i��G __-_ _ CITY/ZIP /L1c:Gk✓ <br /> I Y <br /> CROSS S7`REET v%CL✓ra _-_- APN `F'y��irCl �/ PARCELSIZE �_ C <br /> OWNER NAME ✓4' </1/2i1113/1e/;lam _... . PHONE <br /> OWNER ADDRESS _ (�ra• ar __. __ CITY/STATEIZIP <br /> CONTRACTORf � ) PHONES _ <br /> CONTRACTORADDRESS -� c ��i{.c� Lt9�'✓� _ CITYISTATE/ZIP Zfl- t <br /> I � <br /> LSCENSE ;C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE U <br /> WATER TABLE DEPTH; ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ 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 f,!'i Sh 9 CAPACITY gal #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I LEACH LINES ❑ LEACHING CHAMBERS #OF LINES ^ LENGTH OT LINES <br /> DISTANCE TO NEAREST WELL ft t FOUNDATION 30, ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> :t <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 <br /> SEEPAGE PITS WIDTH , <br /> ft LENGTH ft DEPTH ft <br /> 1 DISTANCE TO NEAREST WELL ft FOUNDATION PROPERTY LINEft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />! MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED; TITLE _/c�a DATE 2011119-3 <br /> i.` <br /> � lz <br /> t s� 11 <br /> o <br /> Ci <br /> dLL <br /> F <br /> _ — - - <br /> DEPARTMENT YSE rNLY <br /> Application Accepted Date O Area Employee ID# S~ <br /> Final Inspection Date 6;6Z ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil 6toDe� of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE Sc Received Chec Amount Permit/ <br /> Code INFO B ash Remitted Date Service Request# Invoice# Permit[D# <br /> 42-01-001 <br /> 1212102 ONSITE WASTEWATER PERMIT <br /> 1 <br />