Laserfiche WebLink
ONSITE WAc"`EWATE A�TMENT SYS"��•�`M PERMIT'` D 3SS/ <br /> $�—JUIN COUNTY ENVIRONMENTAL HEALTF`a.CPARTMENT (1304 E WEBER--d-3r°PL-STOCKTON CA 9520 )9)468-3420 <br /> EFUNDABLE PERMIT CALL 209 'Y53-7697 FOR INSPECTIONS E FIRE$l YEAR FROM DATE ISSUED <br /> JOB ADDRESSD Lr - CITYIZIP SCAMMMm <br /> CROSS STREET APN_6///f5—/50— 4167PARCEL SIZE C- e <br /> a <br /> PHONE <br /> OWNER NAME <br /> CETYISTATEIZIP <br /> OWNER ADDRPss /X� \ <br /> CONTRACTO1,7 21 R �� ��•�c�� PHONE c--- O <br /> CONTRACTOR ADDRESS CITYISTATE/ZIP Q <br /> LICENSE -42 Ll C-36 OTHER NUMBER EXPIRATFON DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X y liy <br /> ❑ PERC TEST # BUILDING PERMIT# - LAND USE APPLICATION# <br /> TYPE OF WORK[ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED!ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIBENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OP LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROFEMPLOYEES: <br /> SEPTIC TANK TYPEIMFG �4- CAPACITY- Sal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG r CAPACITY ga) #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL E- ft FOUNDATION-- 42!D _ fl PROPERTY LME ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> k #OF LINES _ LENGTH OF LINES A/ ft <br /> LEACH LINES ❑ LEACHING CHAMBERS <br /> DISTANCETO NEAREST WELL ft FOUNDATION�{,L_ft PROPERTY LINE ft <br /> ❑ FILTER BED WInTN II LENGTH <br /> R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Cl MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> SUMPS �� WIDTx^�_�__ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Eft <br /> LJ DISPOSAL PONDS WIDT14 ft LENGTH R DEPTH <br /> DISTANCE TO NEAREST WELL FOUNDATION�ft PROPERTY LINE ft <br /> Ll SEEPAGE PITS NUMBER WHY. [.`it� ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE fl <br /> I HEREBY CERTIFY THAT t RAVE PREPARED THIS <br /> STATE APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE <br /> WITH SAN JOAQUIN COUNTY <br /> RULES AND REGULATIONS OF SAN JOAQUIN COUNTY: <br /> MINIMUM 24 HOUR ADVAN E NOTICE REQUIRED FOR INSPE NS-PLEASE CALL(209)953-7697 <br /> C DATE <br /> i <br /> SIGNED TiTLE� <br /> i , <br /> NI I <br /> :r- <br /> R <br />