Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQIIIN COUNTY EIVVIRONMF:NTAL HCALTII DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(20919S3-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS _ I L y��( CrrrY1ZZH. /^� �'(`/(5 16�X <br /> CROSS STREET �t GAF COPE APN (_ i I _, -J'�Ll PARCEL SILE-1.y�1�-- D <br /> . 2-0 <br /> /] �d <br /> OWNER NAME �1,M/�'//������rr�-yyt---"_ F-61�21.�T pR'o pt—CrS PHONE f� Ly <br /> OWNERADDRESS 2W1 f /�J)(�{ r�L—L7 � ��t1� �I 1� F//C+ITV/STATFJZI /���/ ILJ� t Iv <br /> CONTRACTOR L)-A �3I LSI L-�S`'T,I 1 `!V S �'1�+l \�'-1'�PHONE `—`���J6 �) /'� <br /> CONTRACTOR ADDRESS 4 �J• J IL-qp /� ✓�� I CITYISTA1TFIIZIP iJ 1���-+J[JI�'I�'V/`-197_[�S <br /> LICENSE -42 ❑C-36 OTHER A 1�IV l- NUMBER `�5 1 1 E%PIRATION DATE,1105 <br /> WATER TABLE DEPTH: Il GEOGRAPHICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION 4 <br /> TYPE OF WORK: O NEW INSTALLATION ❑ REPAIR/ADDITION Ll ENGINEER <br /> -DS:SIGNED/ALTERN VE <br /> O REPLACEMENT �ry � DE U( <br /> JW TION yct�T ACJ <br /> INSTALLATION WILL SERVE: Q RESIDENCE COMMERCIAL ❑ OTHER_ <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: - NUMBER OF EMPLOYEES: <br /> L <br /> ❑ SEPTIC TANK TN'PE/MFG_ _ CAPACITY gat aI OF COMPARTMENTS!_- <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal 40FCOMPARIMENTS -_ <br /> O PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE tl <br /> O LIFT STATION SIZE— TvPE OFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES O LEACHING CHAMBERS R OF LINES LENGTH OF LINES 1t <br /> DISTANCE TO NEAREST WEI.L R FOUNDATION ft PROPERTY LINE <br /> O FILTER BED WIDTFI _ R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL_ tt FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENiTH _R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION_ fl PROPERTY LINE R <br /> ❑ Sump, WIDTH R LENGTH R DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ R PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> O SEEPAGE PITS WIDTH R LENGTH ti DEPTH <br /> DISTANCE TO NEAREST WELL _ R FOUNDATION R PROPERTY LINE_ R <br /> 1 HEREBY CERTIFY THAT 1 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 /> S1GNE frN <br /> MIN' <br /> � M�24 HCH NCE NOTICE REQUIRED FOR: ONS-P F.AS I.I.(?09)95 DATE lr <br /> T ( loci \ I}-Tlf~�lnl �\) "f1TLF: J <br /> rir- <br /> •1 d <br /> LQL <br /> Ell VIF IONME T L <br /> 1 <br /> LZ <br /> T3'4 ML I <br /> Q <br /> O <br /> 1. 1 L# <br /> v <br /> DEPARTMENT USE ONLY �� <br /> Application Accepted By _ Date ,7- f 7 C ' Arca_02. Employee IDk_ d <br /> Final Inspection By- Date CO oy ❑ SPECIAL PERMIT•Approved by <br /> Character of Soil to pth of 3 FC PIUSmnp Soil Character: <br /> CO WNTS <br /> PE SC Received hee Amount Dale Permit/ Invoice H Permit IDM <br /> Code INFO By h Remitted r Service(R�e uesl# <br /> �{-�-2 �Y/JIiIp S S�7,OCT t7(D b-1 <br />