Laserfiche WebLink
lln- <br /> i ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3-FL-STOCKTON CA 95202 -{269}468-342D <br />` NON-REFUNDABLE PERMIT CALL 20?1 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS CrFy/LIP t�t:s4-AJ-T"F—CA y <br /> CROSSSTREEr fQ APN 2OS-V717 0-1' PARCELSIZE 12, ar V <br /> e <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CITV/STATFJZIP <br /> CONTRACTORAL& ` PHONE <br /> CONTRACTOR ADDRESS CIT VISTATEIZIP <br /> LICENSE ❑C-42 3 C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLEDEPTH: ft GEOGRAPHICALINFORMATIONI Coordinates X y <br /> ❑ PERCTEST H IIDILDINGPERM IT# 60_6349(3" LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED(ALTERNATIVE <br /> 1) REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> 7 <br /> NUMBEROFLIVINGUNITS: NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY Bal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE(MFGCAPACITY, <br /> 991 NOF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE B <br /> ❑ LIFT STATION SIZE TYPE OF PVMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES O LEACHING CHAMBERS 0 OF LINES Z_ LENGTH OF LINES 15-D ``7' R <br /> I DISTANCETO NEAREST WELL ft FOUNDATION A PROPERTY LINE ft <br /> t ❑ FILTER BED WIDTH ft LENGTH ft pgpTIT it <br /> ` DISTANCETO NEAREST WELL [I FOUNDATION It PROPERTY LSNE ft <br /> 1 ❑ MOUNDED wlvrn D LENGTH ft DEPTH ft 1 <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTY UNE ft <br /> ❑ SUMPS WIDTH ,'�j A LENGTH_ /4/ ft DEPTH le4f ft pQ <br /> DISTANCETONEAREST WELL ft FOUNDATION fl PROPERTY LINE fl 1- <br /> r CI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL A FOUNDATION ft PROPERTY LINE ft rn <br /> 1 ❑ SEEPAGE PITS NUMBER WmTst ft DEPTH ft <br /> DISTANCE TO NEA REST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANC ES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MINI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2091953-76071 <br />{ SIGNED <br /> dE-, TITLE DATE <br /> 1'n <br /> r <br />{ <br />+' L <br /> i Q Q <br /> 1 � <br /> IJ <br /> IR N E <br /> f ---#Jt -T- I <br /> L <br /> DEPARTMENT U. LV <br /> Application Accepted - Date Date Z C " Area �[ f EmployeelDif <br /> kI Final Inspection By ' <br /> 13 SPECIAL PERMIT-Approved by <br /> y Character of Soll to De h of 3 Ft: PiUSump Solt Character: <br /> COMMENTS 16 .[A+ O p r' I—• �O �JL S t r4+c s.�T {.E a. <br /> qw <br /> x <br /> PE SC Received h Amount Permitl <br /> Code INFO H Cash Remitted Date Service Request 0 Invoice 0 Permit IDI! <br /> LIZ-if 11-7 5003-75R)9 <br /> 42.02-Ml <br /> 1222/2001 ONSITE WASTEWATER PERMIT <br />