Laserfiche WebLink
i Qf�_ <br /> ONSITE ;WATER TREATMENT S'.� 'M PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEA <br /> LTH �PARTMENT 304 E WEBER-3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PE MIT . CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> cn <br /> -4> O\ CITY/ZIP .:I <br /> JOB ADDRESS / <br /> m <br /> CROSS STREET <br /> /CPN �� b� � PARCEL SIZE, � .}� <br /> OWNER NAME I OL PHONE 1-0 /� - <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> PHONE <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# D t <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ 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 /> ❑ SEPTIC TANK TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 NUMBER WIDTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> I 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 AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 rl <br /> SIGNEDTITLE11 --v DATE <br /> T-T 11 <br /> tl <br /> 44� IT —T- <br /> i <br /> _ J 0 <br /> -CC ITU&I'l <br /> �R N1 N <br /> --HH � <br /> DEPARTMENT US ONL / <br /> Applicatio ccepte Date Area Employee ID# G �� <br /> Final Insp tion Date ❑ SPECIAL PERMIT-Approved by / <br /> Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS j5 <br /> e <br /> PE SC Received Check#/ Amount Permit/ <br /> Date Invoice# Permit ID# <br /> Code INFO By as Remitted Service Request# <br /> % D 5 oD tp 42 <br /> 42-02-001 �i�iy� � � Q� Y�� �� ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />