Laserfiche WebLink
ONSITE WAS;�WATER TREATMENT SYST 4 PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN'r 304 E WEBER Av'r-3"'FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT/-3o//, CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1/YEAR FROM DATE ISSUED <br /> JOB ADDRESS 'V CITY/ZIP (A <br /> _2-cJ't `/ PARCELS .I p <br /> CROSS STREET 2� .�"►�2- �� / - [,C r CJ� J <br /> O <br /> OWNER NAME 7 r Z ,A -C C' �, ./ PHONE ry o `� <br /> OWNER ADDRESS [�"U l,l �f G'L•` y �j CITY/STATE/ZIP <br /> CONTRACTOR PHONE <br /> CONTRAC'T'OR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 [)TITER NUMBER EXPIRATION DATE <br /> WA"I E:RTABLE DF.PIIt: _ It (;EOG14,\I'I11('AI.INI:ORMAT'ION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMI L# LAND USE APPLICATION# �L <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 1 <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: LJ RESIDENCE COMMERCIAL. ❑ OTHER <br /> NUM <br /> BER OF LIVING UNIT'S: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 4 -�C(S�- ti �t CAPACITY ` Zy U gal #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE./MFG _ _ CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE:ro NEAREST: WELL ft FOUNDATION ft PROPERTY LINE g6O p ft <br /> ❑ LIFT STATION SIZE TYPE:Or•PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED W'IDTn ft LENGTH ft DEPTH ft <br /> DISI"ANCE•I'O NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE;TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDT"Hft LENGTH / ft DEPTH / ft <br /> DISPANCE To <br /> N;AREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAV EPA -D THIS AP ICA' ON AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI DVA ? 0' C UI ED FOR INSPECTIONS-PLEASE CALL(209)953-7697 / <br /> SIGNED ��� TITLE� � � DATEIc <br /> �v <br /> 1 <br /> T1 I <br /> 9 <br /> �1/v I <br /> M /V <br /> DEPARTMENT USE PNLY <br /> Application Accepted By Z Date U Area Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dei!_ of 3 Ft: Pit/Sump Soil Character: <br /> ^ n <br /> COMMENTS �y�S�l"�� q�l�p <br /> PE Sc Received j Check# Amount Permit/ Invoice# Permit ID# <br /> Code INFO BV ash Remitted ate Service Request# <br /> 42 02 OOI ITE WASTEWATER PERMIT <br /> 12!22'2001\�— 'f4 Ir( ""5t-1 <br />