Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAH JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3-FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)9517697 FOR INSPECTIONS EXP RES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> p ��PJ-� / CTIY/ZIP <br /> CROSS STREET [ J'riF'N C— 1 /� 1 T <br /> APN Q 6A6 - PARCEL SITE s q a <br /> OWNER NAME PHONE 9 <br /> ONT'ER ADDRE65 CTTWSTATF/ZIP SOC /I / Q <br /> CONTRACTOR P In <br /> PNONE v <br /> CONTRACTORADDRESS CITY/STATFJZIP O <br /> LICENSE 0C4 11 C-36 OTHER UMRER EXPIRATON DATE <br /> WATERTABLEDTPTH: R GEOGRAPHICALINFORMATION: CoorAlnafer X y �. <br /> ❑ PERCTEST M BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAnUADOTON Cl ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT DESTRUCTION .r <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE OMMERCIAL (3 OTHER NUMBER OF LIVING UNITS: NUMBEROFBEDROOMS: NUMBER OF EMPLOYEES: , <br /> ❑ SEPTIC TANK TYPFJMFG CAPACITY EBI p OF COMPARTMENTS r\ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY PI B OF COMPARTMENTS " <br /> ❑ PRIG TX PLANT DI6TANCETONEARESI': WELL RR FOUNDATION ft PROPERTY LINE It <br /> .it LIFT STATION Sae � Y TYPEOFPUM�'-•/�S h' SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES (3 LEACHING CHAMBERS f OF LNES LENGTH OF LINES R <br /> DISTANCETONEAREST WELL It FOUNDATION A PROPERTY LNE R <br /> ❑ FILTER BED WIDTN ft LENGTH It DEPTH It <br /> DISTANCETONEARLtT WELL ft fOUNDATpN R PROPERTY LNE It <br /> ❑ MOUNDED WiDTx R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREET WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DIWANCETONEAREST WELLft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS M.. ft LEND" ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES ANO REGULATIONS OF SAN JOAQUIN COUNTY. <br /> N UM 24 HOUR AD AAMCENOOTTICE.REQUI RED FOR INSPECTIONS-PLEAAS-E.CALL QW)953-769) <br /> SIGNED l�t./� A=�N / TITLE CO V /TQM,/O L L DATE, -2 A <br /> r <br /> E JIM 101M N L <br /> F <br /> • EPARTMENTU O '�f//J► <br /> -- Appli atlon Accepted - ° mm A. Employee IDk / <br /> /p' <br /> Final lRepedionLBy�' G�` - T DRh 13 SPECIAL PERMIT-Appmvcd by <br /> CMnNer of <br /> It.De X of 3 Ft: PLUS.,Stoll CBRneter: <br /> COMMENTS <br /> ,J�-f/�iA• 2= L4EV s�1L14J lig /l*XWff11,& hlag OC %Rd& UUM-.(/ =A2t* 1" f'{fJ.9D <br /> PE SC ReteIFNI CBecldl/ Amount PermiU <br /> Code INFO B m"pi IOD ServlceR ueetk Involcek Permit lDN <br /> /�� toI2fW061,5fft71 I <br /> /ii.7r4 .—i. Cm..-•>U. '; YS Gam' /c. %Y{,Lr. ...�.a.�,torrw..�o seto��r <br />