Laserfiche WebLink
0NS1T>;✓.RSTEWATER TREATMENT SYST.6,..II..eIERM1T Vic• <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E 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 ISSUED <br /> JOB ADDRESS <br /> CITY/ZIP y <br /> m� rl <br /> CROSS STREET -+z�- APN 1-x(.1 l_� PARCEL SIZ. o <br /> OWNER NAME. 112ue�� / rX PHONE <br /> OWNER ADDRESS CITYISTATE/ZIP <br /> CONTRACTOR �' PHONE '5 -� - <br /> CONTRACTORADDRESS G .2 CITY/STATE/ZIP <br /> LICENSE C-42 ❑C-36 OTHER NUMBER c EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> ❑ FERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENCINEFR DESIGNED/ALTERNATIVE -I <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> �r7 <br /> INSTALLATION WILL SERVE: 0-RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LR'INC UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ry <br /> (� SEPTIC TANK TYPE/MFG CAPACITY '; •L'G gal #OF COMPARTMENTS ✓ <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY. gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TU NEAREST: WELL adv it FOUNDATION R PROPERTY LINES' ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SY,srrm) <br /> 29—LEACH LINES 13-LEACHING CHAMBERS Ile #or LINES LENGTH OF LINES SC3 ft <br /> DISTANCE.TO NEAREST' WELL R FOUNDATION SO ft PROPERTY LINE /O- ft <br /> ❑ FILTER BED WIDTH ft LENGTII ft DEPTH R <br /> DISTANCE TO NEAREST WELL R rOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDYH ft LE\GTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH `ft <br /> DISTANCE TO NEAREST WELL ft TOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WEr.L A FOUNDATION fl PROPERTY LINE R <br /> ( SEEPAGE PITS NUMBER S/ WIDTH�!2" _A DEPTH X147 h <br /> DISTANCE I'D NEAREST WELL j4 R FOUNDATION ft PROPERTY LINE //Z, ft <br /> I HEREBY CERTIFY THAT I HAVE.PREPARED THIS APPLICATION AND T-FIE,WORK WILL BE DOVE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,SFATF.LAW'S AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPFC`I'IONS/-PLEASE CALL(2091953-7697 <br /> SIGNED _ 'i TITLE DATE. <br /> i <br /> AJJRA I CIIIJ <br /> N EA <br /> f jr' <br /> Pr! Lc- <br /> J <br /> I <br /> D ARTMEN'T USE NL r <br /> Application Accepted y' Das �- Area _ , Employee ID# .S✓ <br /> FinallnTpectby Dale E3 SPECIAL PERMIT-Approved by 4/ <br /> Character of So pth o 3 Fl: Pit/Sump Sail Character- <br /> COMMENTS A <br /> PE SC Received Ch hdl/ Amou Date Permit/ Invoice# Permit[D# <br /> Code INFO B as Remitted Service Request# <br /> 2 X1 ,`� 0 <br />