Laserfiche WebLink
- - -77 <br /> 2-- ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET-STOCKTON CA 95202-(209)466-3420 <br /> NON-REFUNDA LE PERMIT _ CALL 209_953- 7 FOR INSPECTIONS EXPIRES 9 YEA OM D TE ISSUED <br /> JOB AD ESS I <br /> ` CITY/ZIP rn <br /> CR S STREET1 v APN ~© PARCEL$t2E c <br /> HER NAME <br /> PHONE <br /> I/ ) <br /> OWNER ADDRESS / CRY/S7ATElZIP <br /> CONTRACTOR / tJ PHONE �J <br /> CONTRACTOR ADDRESS Wi�./Il �' CITYISTATrJZIP ' <br /> LICENSE VC-42 ❑C-36 OTHER NUMBER VO©� EXPIRATION DATELL <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#V LAND USE APPLICATION# <br /> TYPE OF WORK: O NEW INSTALLATION O REPAIWADDITION L7 ENGINEER DES N /ALTE TIV <br /> _I REPLACEMENT G OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTIO <br /> INSTALLATION WILL SERVE: RESI ENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG_rs L CAPACITY gal #OF COMPARTMCNTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL Sn+ ft FOUNDATION It PROPERTY LINE_ ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 0 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft P P RnTY ft <br /> FILTER BED WIDTH��ft LE H ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION 'IftIt PROPERTY UNE k <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTI4 ft <br /> DISTANCE TO NEAREST WELL ft FOUNOA'ION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH, f It DEPTH ft <br /> DISTANCE TO NEAREST WELL (l FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH k <br /> DISTANCE TO NEAREST WELL k FOUNDATION it PROPERTY LINE ft <br /> 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 /> M ill CE REQUIRED FOR! E lvE CALL 209 -769 <br /> SIGNE A�ULVTITILECAMUM DATE <br /> I <br /> _ I <br /> I t <br /> I <br /> pwflil El T <br /> C U I <br /> D P A R T M E N TiV SEO N LY <br /> App7icadonAccepteq - "°'T^Date J- L-1`Aiea"��'-`'"' F�nployeelD# !! <br /> Final Inspection By Date6 :1 SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: P' Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check Amount Permit) <br /> Code INFO B emitted Date Service Re uest# Invoice# Per It ID# <br /> VT <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5121!10 <br />