Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT EOIIIS6 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 3N E WEBER AVE-3"PL-STOCkTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTN)NS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS t CITYaAp �j 7 <br /> CRO.CSSTREET WIG WCNTTYYI r�/^1 fI APN_.o�a�^�ID-'On PARCEL SIZE� <br /> G {�wv+ei <br /> OWNER NAME l�I(w LYN y'��I(r/ L1 ra L'b. r <br /> O%NERADDRFSS P.O• !k] Jr� �nC ry//ST3ATErL—IP �,�1 <br /> CONTRACTOR ll \ Q S(Y(]AI,J,\LY`�- � Ll PHONE 1 ''��j6 4 7/2 1 <br /> _ CONTRACTOR ADDRESS CSG fI7I //)h CITY/STATEalP <br /> LICENSE ❑C-42 ❑C-36 OTHER NL'MBEN EXPIRATION DATE_ <br /> WATER TABLE DEPTH:— R GEOGRAPHICAL INFORMATION: Coordinates X V I,v' <br /> PERC TEST(S) NUMBER I LAND USE APPLICATION M <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DFSH:NED/ALTERNATIVE v- <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER__ {\J <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: <br /> r ❑ SEPTIC TANK TYPE/MFG— CAPACTY Bal P OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFGCAPACITY gal M OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION A PROPERTY LINE _It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL.SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES O LEACHING CHAMBERS ll OF LANES _ LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH It DEPTH <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE it <br /> ❑ MOUNDED WIDTH R LENGTH _it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ ft PROPERTY LINE it <br /> I] SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ^ft FOUNDATION_ ft PROPERTY LINE ti <br /> r_ O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LME ft <br /> ❑ SEEPAGE PITS WIDTH it LENGTH It DEPTH ft <br /> DISTANCE TO NEA REST WELL ft FOUNDATION ft PROPERTY LINE }t <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND-1'HE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> A NIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 n (� <br /> SIGNED NOA — TITLE—�/. I / UATE D5�5�0 7 i <br /> yt n a r>< <br /> c O d C <br /> 'oil 1j8 r d <br /> Q � <br /> Pl lj`yr F <br /> t,I <br /> r <br /> ►ARTMENT SE <br /> Application Accepted By 2JDa4 G Area .tel/ y Employee ID#_V /9 t <br /> Final Inspection Rylodt— Date O SPECCf;L PE/RMIT-Approved by <br /> Charaeter of Soil to th of 3 FY: _ Pit/ .1 Soil Charaefer. <br /> COMMENTS /G2 <br /> ;p 1(. 0') i/o3 '3.80,97co <br /> PE SC Received Cha Amount Dote Permit/ Involmel Permit IDN <br /> Code INFO B ask Remitted Service Reoucia k <br /> VFlo <br />