Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR IN PECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESSZX00X61, CITY2IP O G dl�- Lq <br /> CROSS STREET D/ APN /,Y/- 171,2 - Q 0 (1 PARCEL SIZE 17 C p <br /> OWNER NAME / /��/ U O!r/ /SF/E' ` / S PHONE f2/ <br /> OWNERADDRESS �OV ��v -�7 �GG�� CITY/STATE21P ✓�UL O �` <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 11C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT -1 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL VOTHER 1-14k: <br /> NUMBER OF LIVING UNITS: A I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: G <br /> SEPTIC TANK TYPE/MFG T a //)S gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLAT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> /¢¢ &,61- v /Ion/,/�r/0Sa c_OV41 <br /> L3LEAe�(NES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> �QQ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> L3FIL�fER BED WIDTH ft LENGTH ft DEPTH ft <br /> /� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> [3Na)aD 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 /> L3DISb- 2 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> POSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> IDISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> 13 S/E� AG _ft <br /> E PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I 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 /> MINI UM VANCE NOTICE REQUIRED FOR INSPEC NS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE /�l/7'l[/!" DATE <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10/4/07 <br />