Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> \ t7w� / -PLACD� -ISZZU <br /> JOBADDRESS2 9OCROSSSTREET APN 00'T 100 ) �• PARCELSIZE C <br /> OWNER NAME S N(2\� PHONE N I wt Q <br /> OWNER ADDRESS jAMt 'AS A33JC- /� C"/STATE/ZIP H <br /> CONTRACTOR WCSZ Car'" \ti A11AYEI I^/C a�-/01,2IPHORE- <br /> CONTRACTOR ADDRESS 21 MXLJtlk S17 Fq') CITY/STATEMP LJ\i CA "%5t SIJ S <br /> LICENSE 40.42 QC-36 OTHER T0511> I NUMBER ^ E%PIRATIDN DATE <br /> WATER TABLE DEPTH: b it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT 11 LAND USE APPLICATION 1f Z <br /> TYPE OF WORK: NEW INSTALLARON F. REPAIRIADDITION J ENGINEER DESI NED/ALTERNATIVE <br /> O OUT-OFSERVICE SEPTIC SYSTEM 1 DESTIUCTION 5- <br /> INSTALLATION <br /> INSTALLATION WILL SERVE: El RESIDENCE COMMERCIAL ❑ OTHER fL <br /> NUMBER OF IAVINO UNITS: NUMBEROFBEDRO0MS: }}�� NUMBER OF EMPLOYEES: AN <br /> 10, SEPTICTANK TYPE/MFG P1L CAPAC9"��// Ioeo gal #OFCOMPARTMENTS Z <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal IT OF COMPARTMENTS <br /> DIBTANCETONEAREST: WELL S:' It FOUNDATION IO 1I PROPERTY LINES it 3 <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT E3 SAND OIL SEPARATOR)ENCLOSEO SYSTEM) <br /> ❑ LEACH LINES A LEACHING CHAMBERS tN(`I\fA'4+Y IT OF LINES 3 LENGTH OF LINES IOP 1t <br /> DISTANCE TO NEAREST WELL N FOUNDATION I17 it PROPERTYUNE It V <br /> ❑ FILTER BED WIDTH IT LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> O MOUNDED WIDTH it LENGTH ft DEPTHif <br /> DISTANCE TO NEAREST WELL R FOUNDATION N LL PROPERTY LINE it It <br /> ❑ SUMPS WIDTH it LENGTH it DEPTH J it <br /> DISTANCE TO NEAREST WELL It FOUNDATION K PROPERTY LINE it <br /> LIDISPOSALPONDS WIUTK R LENGTH it DEPTH 'N 0 t 1t <br /> DISTANCE TO NEAREST WELL K FOUNDATION ft PROPERWUNEIf O ft <br /> f SEEPAGE PITS NUMBER WImH S , ft DEPTH M nl/En - ft <br /> DISTANCE TO NEAREST WELL_ � K FOUNDATION tq' R PROPERTY LINE S 1t <br /> THEREBY 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE -I� <br /> NN <br /> rT <br /> Wei <br /> W ,v <br /> ( - <br /> f <br /> ID <br /> L <br /> DEPARTMENT USE DNLY �j W_ .y-[, <br /> Application Accfpyd Date_ Area �~�_ Employee IO#4 _CM7.(l —.. <br /> Final Inspection B� - Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil tD pth of 3 Ft: PIUSUmp Soil Character: _ <br /> COMMENTS - P• •y. L.li — d'.PJ =z -5A&IE!o <br /> PEC <br /> Received h Amount Permit/ <br /> Code INF. B Ceah Remitted Date Service Request# Invoice N Permit lD# <br /> X290 OK-7 <br /> urnrIE75��}�G Punt 6 Hifi r loos sir 8/uryr/yjt� [map tc <br /> d2-01 Cl�t.7'J�iG>!cz 2?, 4M/�cr-rte 7r 4-31 -Jdl/I/3 ONSITE WA6TEWATER TRTMNf SYSTEM PERMIT <br /> l: <br />