Laserfiche WebLink
ONSITE WASTEWATEP "REATMENT SYSTEM PERMIT <br /> =N JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT \ J 309E WEBERAVE-3YO PL-STOCKTON CA 9520* 9)i 3420 <br /> NON-REFUNDABLE PERMIT1 CALL 209 9955{33---7697 FOR INSPECTIONS t EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS l 'T ', ' " Y_. 1� .� CRY/ZIP 1 i =- p <br /> no <br /> CRoss STREEF '•1'F✓�=:"r+. ! r APN 21i ` - it N. _'? �- (PARCEL SIEE V p <br /> OWNER NAME — l 1\�T�. �^' <q. �..`E� PHONE <br /> O"GRADDRESS /� �''"' 1- < t'^ '-1- �' CITY/STATE/ZIP <br /> Ti <br /> CONTRACTOR qq!`l( T PHONE <br /> CONTMCTOR ADDRESS COV/STATE/ZIP <br /> t.: <br /> LICENSE LI C-42 01 C-36 OTHER NUMBER EXPIRATION DATL T <br /> WATERTABLE DEPTH: R GEOGWPNIGLINFORMATION: CoordinateF X Y <br /> ❑ ,ERC TEST # BUILDING PERMIT# LAND USE APPLICATION#F -`1�' <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER.,SIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: EIRESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER.,LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPF/MFG CAPACITY gal #OF COMPARTMENTS ` <br /> ❑ GREASE THAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> PKG TX PLANT DISTANCETONEAREBT: WELL R FOUNDATION ft PROPERTY LME R <br /> ❑ LIFTSTATION Stze TYPEOPPumP ❑ SAND OIL SEPARATOR(ENCLOBEDSYSTEM) <br /> 60 13 LEACH LINES ❑ LEACHINGCHAMBERS #OPLINES LENGTH OF LINES ft 1 <br /> DISTANCETONEARESI' WELL ft FOUNDATION R PROPERTY LINE R <br /> O FILTER BED WIDTH R LENGTH ft DEPTH it <br /> DISPANCETONEARPSP WELL R FOUNDATION R PROPERTY LINE R 1 <br /> `O MOUNDED WIDTH R LENGTH_ ft DEPTH It <br /> DISTANCETONEAREST WELL A FOUNDATION R PROPERTY LOU ft <br /> ❑ SUMPs WIDTH R LENGTH ft DEPTH ft C <br /> r <br /> DISTANCETONEARE6T WELL R FOUNDATION R PROPERTY LME ft <br /> DISPOSAL PONDS WIDTR R LENGTH_ ft DEPTH ft <br /> `O <br /> DISTANCETONEARPSI' WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS Nuou EII W. ft DEPTH ft <br /> DIS ANCETONEAREST WELL ft FOUNDATION ft PROPEETY LINE ft <br /> lin, 1 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 /> MINIMtX M HOU R ALA ANCErTICE REQUI RBD FOR I NSPECTIONS-PLEASE CALL 12091953-7697 ' <br /> SIGNED�� �-- a TITLE DATE <br /> t <br /> - .A, S as <br /> sD.a <br /> - 0-ePt'! AE16 <br /> o K <br /> 91-OOG-BYC �T9F IX' - �v <br /> anYtw L�3Jb'v4_ - <br /> •fi- AL'M q- C_ <br /> flMM . „ IIJtl Ytl- j7 <br /> F,-goo-mx poxs, � = <br /> n.� <br /> e s <br /> a < <br /> vwcm n ovc "' E <br /> A o sc-9ex-rcx <br /> DEPARTMENT Ug O/dLY S/ <br /> Application Accepted BY 11 , Date- 2 k/�'r A,. 'Z f Employee 1f� <br /> Final Inspection By Date- 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of3 FL PItlSHmp Soil Character: <br /> COMMENTS <br /> PE SC Receivmo <br /> ed GIswIJU Aunt PePerndt IDN <br /> rmltl <br /> -72 <br /> L4 III <br /> Code INFO B Cveh Remained¢d Ua ServlceR un[# Involve# <br /> `042U2-061 ONSITE WASTEWATER PERMIT <br /> IL MON <br />