Laserfiche WebLink
,ASAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DE' -TMENT 394 C WEBER AVF 3`°FL-STOCKTON CA 95>e- % fp/,L.,:y, <br /> CCNON-REFUNDABLE PERMIT .ALL[209�� �GJ7 FOR INSPECTION'S ?XPIRES I YEAR FROFi�-°•9351166 = -J <br /> �ry m <br /> JOB ADDRESS V - CITY/ZIP <br /> CROSS STREET APN�I3�'I3o 1 PHONE Otr0 'P]ARCp-t�7 fEL/Z�J p-3 94-1 <br /> - � <br /> All <br /> OWNERNAME <br /> OWNER ADDRESS �� - CITYlSTATEIZIP <br /> CONTRACT�.IpaO��R <br /> PHONE <br /> CONTRACTirR ADDRESS CITY/STATE/ZIP <br /> (rte <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE ' <br /> WATER TABLE DEPTH: 72 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# h <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION [3ENGINEER DESIGNED(ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION it <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER 1. <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: N UMBER OF EMPLOYEES: -� <br /> SEPTIC TANK TYPEIMFG' '1':1 e�-M_ CAPACITY / L [/ _ gal NOFCOMPARTMENTS ` 1� <br /> ❑ GREASE TRAP TYPOMFG Gerry, CAPACITY gal 40FCOMPARTMENTS (n./ <br /> ❑ PKG TX PLANT—DISTANCETO NEAREST: "WELL, ' .� v ft FOUNDATION lin ft PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> .7 / <br /> �[ LEACH LINES Z) LEACHING CHAMBERS 9 OF LINES_ .__ LENGTH OF LINES_! S ft <br /> •- DISTANCE TO NEAREST WELL ft FOUNDATION <br /> $ PROPERTY LINE fl <br /> ❑ FILTER BED will R LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH; tt LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FFOUNDATIGN ft PROPERTY LINE R <br /> SUMPS WIDTH _ It LENGTH `� ft DEPTH (l .fig ft <br /> DISTANCE TO NEAREST WELL Q H FOUNDATION f-6 R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS Wi ft LENGTH ft DEPTH ft <br /> DISTANC TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WID R LENGTH <br /> ft DEPTH <br /> r <br /> DISTANCE 70 NEAREST WELL DATION ft PROPERTY LME ft <br /> 1 HEREBY CERTIFY THAT l 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 /> IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED. - <br /> 7[TLE' � -- DATE 2 O <br /> IE I <br /> 4A AAMI IN <br /> l <br /> fli ISh p R "d 4�cprF <br /> LJ I LJ I tan 18"will iin an <br /> 15 T-IU <br /> 3 MF E <br /> DEPARTMENT U§C ONL# <br /> Application Accepte*Deof <br /> 3 ateIr Area L� Employe IDtl M <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by ! 7 <br /> Character of Soil toFt: Pltl mp Dil Charocler: <br /> COMMENTS - OTOO I IT r ! 73 <br /> ' -i sz " .0 [34 .SRL <br /> 2 7 /Y ✓' <br /> PE SC Recdved C eekt!/ Amount Date Permit! Invoice ft Permit ID# <br /> Code INFO B as Remitted Service Req,est# <br /> -1 <br /> 42-01-001 �� ,�y, LIQ/n�(lt.Ol(q.• ^1c.z-S t N STEWATER PERMIT <br /> 1212102 •.�zo lam..(-+%/rtYL.S�w rrJ t12Y�S— cc,C✓7/FdFr is"�rLeZtY Y4lYs� - 3.CS/d , 4.cirr.�J <br />