Laserfiche WebLink
UU1- LJU- 4V <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUND L C LL 209 953-7 7 OR INSPECTIOf� EXPIRE 1 YEAR F S D <br /> JOB ADDRESS -".E '1 A CIITrJTjYfzIIp •. �l <br /> CROSS STREET {•�{{ L N [/t/! ' o�- PARCEL SIZE , <br /> S yi 1 <br /> OWNER NAME J n JL"v 10 PHONE <br /> WMOWNER ADDRESS CITlYISTAT P c <br /> CONTRACTOR rte• T ILS"�G.--'�1' `� \v PHONE Z. <br /> CONTRACTOR ADORES. f !jj:)0 W- " CITYISTATE/ZIP <br /> LICENSE IXj,C-42 I,!C-36 OTHER A NUMBER EXPIRATION <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # [ BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 1 NEW INSTALLATION REPAIR/ADDITION Cl ENGINEER DESIGNED/ALTERNATIVE <br /> 11 REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM U DESTRUCTION (� <br /> INSTALLATION WILL SERVE: 11 RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: ^. / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> W SEPTIC TANK TYPE/MFG V"(:I CS 3 V :- Q CAPACITY gal #OF COMPARTMENTS r <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY <br /> gal #Of COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP U PKG TX PLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATIO fl PROPERTY LINE h <br /> FILTER BED WIDTH 1• / ft L fl DEPTH fl <br /> DISTANCE TO NEAREST WELL 1 fl FOUNDATION 7 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 WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ___ft <br /> I HEREBY 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 /> M{I1WVA 24 HQUR V4Nt♦Ct #$Tlibg REQUIRED FOR INSPE.C.TIONS 1 P494SE CALL(209)953-7697. • <br /> SIGNED 1 I �. -•-� TITLE / lit1 DATE".- <br /> WYk . <br /> _ R�QEr.d <br /> SEP062 <br /> .`r <br /> EK <br /> l A� <br /> ter... s 3 ,c �'-�,�►�!-_i <br /> TY PAM I Fpc 19 <br /> �`'°-ate� _-- )� � .... � -_aw;1: •'� � � • <br /> 'P�TTII'4211Y ��.\ v-:v. ti•�jT��9$'f;^�'.'M \\w • <br /> Application Accepted-0Y Area Em0loyee ID# <br /> P SPECIAL PERMIT-Approved by <br /> Final Inspection f�yf f ` f.�__..___ Date <br /> Character of Soil to Depth of 3 Ft: PiOSump Soil Character: <br /> COMMENTS �� ��� hi� /`�Li L /� ` �i� l�+.+ rtr- Jr:Z-t <br /> PE SC Received Chec Amount Date Permit] Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> L2 <br /> ' ()o + ?-700�Q V - s v - d✓ �NSITE 270c)5ER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> 9121110 <br />