Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COON' 'VIRONMENTAL HEALTH DEPARTMENT -,WEBER AVE-3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDA ERMIT CALL(209)953-7697 FOR INSPftAOSS EXPIRES 1 YEAR FROM DATE ISSUED <br /> / <br /> JOB ADDRESS i.F%�� CITY//ZIP C!d �G <br /> CROSS STREET �•7I71, li APN nn�('1�� 5-s PARCEL SIZE S o <br /> A <br /> .� OWNER NAME /JU/U,./� /C/7?Y11Y11 PHONE ���- <br /> OWNER ADDRESS 'J20II1 KCITY/STATE/ZIP <br /> CONTRACTOR Cc- �' wz �/ �s PHONNE ?(y'S -'-7 <br /> CONTRACTOR ADDRESS 77/Lf-V L7�.7,E''i2�'c.� �/1..[/� CITY/STATE/ZIP 1.Ge <br /> LICENSE 11C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE G' <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X \' <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION /LY. REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG LX/!�4WG CAPACITY /Se[/ gal 40FCOMPARTMENTS G <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION fl PROPERTY LINE fl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> JJ c <br /> LEACH LINES ❑ LEACHING CHAMBERS #of LINES�_ LENGTH OF LINES 7� H <br /> +• DISTANCE TO NEAREST WELL (jrJ_�ft FOUNDATION ft PROPERTY LINE 75' fl <br /> ❑ FILTER BED WIDTH ft LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R 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 fl DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTHS ft LENGTH Fl DEPTH IaS ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATIONyPROPERTY LINE It <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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-P//LEASE CALL(209)953-7697 <br /> SIGNED TITLE � /A� DATE G -S <br /> 1 <br /> S �O-Tum, <br /> ES Voc ON <br /> UB 1A�rIE <br /> c <br /> 1' W <br /> DEPARTMENT IJS ONLY <br /> Application Accepted By G'`1' �1_w Date 1 -- Area 2 Z Employee ID# <br /> Final Inspection By - Dale ���3 ElSPECla1L PERMIT-Approved by <br /> Character of Soil to pth o <br /> Def 3 Ft: a. Pit/Sump Soil Character: <br /> COMMENTS<7 t y 4✓rte �' d C � tri d��/i ire k �sr)'' ^:'^'==='-=G moi_ _ / ir. ,...i :int,- (, ;-�T� �-72-���:�r,:'>o-..->--1:���i, _ .-r�-,cr:• <br /> �. `PE `SC Received _--Che / Amount Permit/Code INFO By ash Remitted Date Service Request# Invoice# Permit ID# <br /> O 5'RVC5LI <br /> 42-01-001=�cam,. ..� �f <br /> W <br /> i <br />