Laserfiche WebLink
ONSITE WAST- -/ATER TREATMENT SYSTI PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEJ""r'NIENT ` <br /> 304 E WEBER AVe"-'�"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERN11T CALL(209)953-7697 FOR INSPEC IONS <br /> FRREE <br /> ESS �S� ,/t/, 1 - EXPIRES 1 YEAR FROM DATE ISSUED <br /> " CITY/ZIP <br /> T el0 tv1v fcv Al/j w APN_ PARCELSIZE 3, <br /> ME 1A7.JI�J/ g// (� <br /> Q r� J ✓ PHONk: /t/6 T Z <br /> OWNER ADDRESS �y 0 (t/�� � �S� k Kn.! �s�Uv� A <br /> \7 CITY/STATE/ZIP (.1 Z— (r 1 1�1 7 <br /> CONTRACTOR /'1 OQ,✓ Q f- S2T (��� ! <br /> PHONE <br /> CONTRACTOR ADDRESS 171 <br /> CITY/STATE/ZIP— <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBERQ <br /> 75'��a EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> l' <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# O Qv (�( <br /> TYPE OF WORK: NEW INSTALLATION❑ L3REPAIWADDITION <br /> ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: jLIRESIDENCe COMMERCIAL ❑ ONUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES: <br /> EPTICTANK TYPE/MFb /;riyff7—s6;T/C CAPACITY ZDV_ gal #OFCOMPARTMENTSCREASE TRAP TYPE/MF C Q�131-0 /�j,�a/aCy17�j� CAPACITY tUV gal #OF COMPARTMENTS Z <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br /> ti <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS �(--W4� je #OF LINES LENGTH OF LINES_ CJ ft <br /> DISTANCE TO NEAREST WELL -261) ft FOUNDATION Z O ft PROPERTY LINE ,jO ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ MOUNDED WIDTH tt LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft (� <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft "{ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft 'LENGTH ft DEPTH_ fj <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH ft LENGTH <br /> �7,ft DEPTH �� ft <br /> DISTANCE TO NEAREST WELL f[ FOUNDATION ,Z® ft PROPERTY LINE Z ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> TE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 r <br /> G <br /> SIGNEDTITLE 01/V"*fA'14�- DATE l <br /> JU <br /> ob <br /> I , <br /> i <br /> J <br /> O <br /> - P <br /> t. VRO M N <br /> N LT <br /> /^ DEPARTMENT USE ONLY <br /> Application cep y 11/ � Date Arca Employee ID# <br /> Final Inspe tion By Dat ❑ SPE PERMIT-Appr`o�,ed by ------ <br /> Character <br /> Character of o Dept of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS /3C7 3 :3 3 I`(G neC� er!e 2- a..�c eC 2 ct " Pam-� 1�.•es <br /> c X.� <br /> PE SC Received Check# Amou" Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 12/2/02 <br />