SU0004600 - Laserfiche WebLink

Home Browse Search

ONSITE WAS' ";WATER TREATMENT SYST"M PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH Nw`ARTMENT 304 E WEBER.`� -3"'FL-STOCKTON CA 95202 - (209)468-3420 ON-REFUNDABLE PERMIT/ L CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED OB ADDRESS S / I e (j-YL CITY/LIP s L tti ti Z CROSS STREET APN ( J �`�JO- O PARCEL�SIIrZE(J. OWNER NAME .�-� /-� //{ y '� I ( I I C PHONE 14 f OWNER ADDRESS 3 .J/-- ll L T ^ CITY/STATE/ZIP 1 U c ( t yy (/��_7Z1 1 CONTRACTOR ��/— ( IJ PHONE G 9 rZ �S L4 �l CONTRACTOR ADDRESS T�Fi !` 3C 3 C;_� �- S CITV/STATE/ZIP / (- C. �.w.-. 1 C `� LICENSE ❑C-42 ❑C-36 OTHER NUMBER d EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERCTEST(S) NUMBER LAND USE APPLICATION ft TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE 11 ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL ft FOUNDATION H PROPERTY LINE fl ❑ FILTER BED WIDTH ft LENGTH fl DEPTH - It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH R LENGTH ft DEPTH ft DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ DISPOSAL PONDS WIDTH ti LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It I HEREBY CERTIFYTHAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, 11 STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ( �. //I'�� 'MINI M 24 HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 y IGNED TITLE �S e;YL�i DATE__ N I v ,jjfeoJ b.',,� c r 777 40 �� ... . y� yg^o,f�s � Mous c 74 EPARTMENT UNc.v�.i, ) Application Accepted By D V"wJ"� �` `� ` Date�_,� Area Employee ID# Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received F Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service Re nest# 42-01-001 un J n T �_ A ONSITE WASTEWATER PERMIT 122/02