Laserfiche WebLink
j� G ) <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT � � <br /> SAN JOAQUIN CODNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE -3"'FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS /EXPIRES I YEAR FROM DATE ISSUW <br /> JOB ADDRESS z'f CITY/ZIP <br /> C0.05S STREET ,....//.lam�. A/P,[NT/ni / l I +�PARCEL SIZE J JitJ /T V <br /> OWNER NAME __.� !�'� f T11.E ( L� f(� <br /> PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP7411k //4M&2 <br /> CONTRACTOR PHONE <br /> ��--/i iVU Jr/pA�- (PHOONN�E <br /> CONTRACTOR ADDRESS Zb Z- /F ��/2X�L-JS— CITY/STATE/ZIP <br /> LICENSE ❑C-42 Ll C-36 OTHER NUMBER EXPIRATION DATE ' <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST(S) NUMBER Al 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 /> ❑ SEPTICTANK TYPE/MFG CAPACITY gat #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gat #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 /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS I WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PRE AREDTHIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> / ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> iN N 4 UR ADVANCE NOTICE REQUIRED FOR INSyPPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITIL QiNG/N DATE L�3 <br /> i <br /> �Nha� iyo �P <br /> -uMa. i <br /> E E <br /> i 1 (p) 4 <br />