Laserfiche WebLink
ONSITE WASTE TER TREATMENT SYSTEINERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPAK ENT 304E WEBER AVE -7^L-STOCKTON CA 95202 - (209)465-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS <Ra7WCITY/ZIP (/P1DD <br /> CROSS STREET �eIt f� pN''•`� J2Id[ APNCO7-370 -& 17 PARCELSIZESI/n•)(ao <br /> OWNER NAMEkno-bePIONE20( N(k^3 —10 <br /> kC <br /> OWNERADDRESS a6aq jac` hCITY/STATE/ZIP Ze'd( <br /> CONTRACTOR PHONE e 34 -�3 <br /> 76 <br /> /6AJ <br /> CONTRACTOR ADDRESS <br /> • <br /> {i�Cri <br /> CITY/STATE/ZIP I&t' IV �r <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER_ _ EXPIRATION DATE <br /> WATER TABLE DEPTH: Il GEO(iRAPIIICAI•INPORMA'TIONI Comchnales —X "—_ V <br /> FERC TEST(S) NUMBER LAND USE AI'I'I.I('A'I IDN ll_ _ <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER 6ESIGNED/AtARNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: �J <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS `I , <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS I" <br /> ❑ PKG TX PLANT DISTANCETO NEAREST: WELL D FOUNDATION Il ROPERTY LINE Il <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ SAND OILS ARAT ( C se , r� <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES fl V(lq/ <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R V <br /> ❑ FILTER BED WIDTH R LENGTH Il DEPTH R <br /> DISTANCE To NEAREST WELL Il FOUNDATION_ ____It PROPERTY LINE Il <br /> ❑ MOUNDED WIDTH Il LENGTH Il DEPTH Il <br /> DISTANCE TO NEAREST WELL R FOUNDATION Il PROPERTY LINE Il <br /> ❑ SUMPS WIDTH D LENGTH Il DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION______ _It PROPERTY LINE Il <br /> ❑ DISPOSAL PONDS WIDTH Il LENGTH _ It DEPTH tt <br /> DISTANCE TO NEAREST WELL Il FOUNDATION 17 PROPERTY LINE It <br /> ❑ SEEPAGE PITS WIDTH Il LENG'I'll 11 DEPTH It <br /> DISTANCE TO NEAREST WELL Il FOUNDATION R PROPERTY LINE Il <br /> I HEREBY CERTIFY THAT I 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 /> 6 INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE `Q DATE <br /> R .f/ ,00 v <br /> .IPf 9. d6'6h`{ <br /> v 1799 <br /> Wel).) <br /> v, <br /> ,If'f99 <br /> 66 r;9 1 S I C O <br /> _ f_Gl9 I in t <br /> C <br /> • 0 <br /> N e a <br /> ac <br /> L - <br /> .�7:7JS9 :R,JO,00 Ir ,11'll9 ;R,JO.� 'N <br /> < m W — ,109ef oalaJ W o IreDJ o E�' IV•ED <br /> .o .171?6l� <br /> a <br /> 8 <br /> r <br /> E VIR N E T <br /> DEPARTMENT O YIJ FITMENT <br /> Application Accepted By to Arca Employee I D# y/�ff <br /> Final Its <br /> By Date ��Q ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil C •reeler: <br /> COMMENTS i0 <br /> PE SC Received heck!/ Amount D e Permit/ J. ib ce# Per <br /> Code INFO B as emitted Service Request# <br /> d <br /> 42 01-001 <br /> 12/2/02 .�.'.$ o•? trj- d.�'t e77./S ONSITE WASTEWATER PERMIT <br />