Laserfiche WebLink
`y' ONSITE WASTEWATER TREATI�IT SYSTEM PERMIT <br /> ` SAN JOAQUINCOUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3"FL-STOCKTON CA 95202-(209)46&3020 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> ' JOB ADDRESS �L �T` � IN <br /> APN _ r PARCELSIZF <br /> CROSS STREET y - +• U <br /> OWNERNAME ) ` - e ( PHONE <br /> 1 �, `c (,e. C� r L` RY/STATF21P 1 ` ' ♦ r -- <br /> ' OWNER ADDRESS A C <br /> L CONIIUCIOR I�-I✓n l PHONE V''~ T• .`- <br /> CONTRACTOR ADDRESS ClIV/SFATFIZIP <br /> LICENSE 13 C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATLRTABLEDEPTH: R GEOGRAPHICALINFOEMAnom CoorOitotee X Y Taw �A7r <br /> PERC TEST M BUILDING PERMIT# LAND USE APPLICATION# <br /> TWE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGIN¢ER DESIGNED/ALTERNATIVE <br /> C) REPLACEMENT <br /> L1 DESfRUCDON <br /> INSTALLATION WILL SERVE: ❑ RESIDENCe ❑ COMMERCIAL ❑ orm <br /> NUMB¢a OP LIVING UNITE: NUMSER OP BEDROOMS: NVMBEP OP EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEINFO CAPACITY Eel BOF COMPARTMENTS <br /> ` ❑ GREASE TRAP TYPE/MFG CAPACITY Tal BOFCOMPARTMENTS <br /> ❑ PKG TX PWNT DISTANCETONEARER: WELL R FOUNDATION ft PROPERTY LME R <br /> - ❑ LIFT STATION SIM. TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i <br /> L ❑ LEACH LINES ❑ LEACHING CHAMBERS BOFLINES LENGTHOFLMES ft <br /> OISTANCETONEARESI WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTN ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> V ❑ MOUNDED WIDTH-ft LENGTH R DEM R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LME R <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME R <br /> `.. ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH If <br /> DISTANCETONEARElT WELL ft FOUNDATION ft PROPERTY LME ft <br /> [ISEEPAGE PITS NUMBeR Wmm It DEPTH ft <br /> DISTANCETONEARESI WELL ft FOUNDATION R PROPERTY LINE ft <br /> V <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED T APPLICATION AND THE WORK WILL BE GONE IN ANWITH SAN JOAQUIN COUNTY <br /> - ORDINANCES,STATETE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN QUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> L SIGNED T. - ---". TITLE �.- \.. DATE Z.L <br /> t <br /> I I <br /> I <br /> L <br /> f <br /> L <br /> H <br /> DEPARTMENT USE ONEV <br /> Application AcceptM By �--( Data12 i °' C Dena Employee IDB <br /> Final lDSpoe,don By Data ❑ SPECIAL PERMIT-Appmvedby <br /> a000 Character of Soil to Depth of 3 Pt: Pit/Sump Solt Character: <br /> COMMENTS <br /> LpE SC Recel M LChec d/ Anwunt Doh P.TIIJI/ In k.# Perna IDB <br /> 490E INFO B Caah ReMtfeO ScrWee ueNB <br /> 1 <br /> r ONSITE WASTEWATER PERMIT <br /> 42-02-001 <br />