Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE.-3'"FL-STOCKTON CA 95202 -(209)468.3420 <br /> NON-REFUNDABLE PERMIT ' C L1, 209 95 -7697 FOR INSPECTIONS EXPIRES 1-��YEEA_R/FROM DATE ISSUED <br /> JOBADDRESS D / C.�s Y ' <br /> CROSS STREET / B W r�1, APN 3 a� D`U PARCEL SIZE o <br /> OWNER NAME G � ✓ ' IS PHONE//�Y'�//^,�r3/ <br /> OWNER ADDRESS O CITY/STATFJZIP Sr .,� '"r• � ^` <br /> CONTRACTOR N L PHONE <br /> CONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE 2 ❑C-36 OTIIER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y I`- <br /> ❑ PERC TEST N BUILDING PERMIT N LAND USE APPLICATION# \/I <br /> TYPE OF WORK: N EW INSTAL LATION ❑ RI:PAIR/ADDITION ❑ ENGINEERDESICNED/ALTERNATIVE "J <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> J <br /> INSTALLATION WILL SERVE: ❑ RESIDEVCE Ar COMMERCIAL ❑ OTHER <br /> tYyy NUMBER OF LIVING UMTS: NUMBER OFF BEDROOMS: /� NUMBER OF EMPLOYEES: - 0 <br /> Os_ SEPTIC TANK TYPE/MFG n/ {... CAPACITY_�Ov gal N OF COMPARTMENTS_�L <br /> ❑ GREASE TRAP TYPE/MFGCAPACITY gal N OF COMPARTM ENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEARFST: WELL '' jOAlli 0 FOUNDATION 1/100 ft PROPERTY LINE. <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED <br /> /SYSTEM) C� <br /> v \ LEACH LINES ❑ LEACHING CHAATBERS /7 �1_ a OF LINES 2 '— <br /> LENGTH OF LINES / O <br /> DISTANCE TO NEAREST WELL L �1/Aft FOUNDATION 2oy R PROPERTY LINE. � fl <br /> L3 FILTER BED WIDTH R LENGTH R DEPTH fl <br /> DISTANCETO NEAREST WELL R FOUNDATION ft PROPERTY LINE H <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH fI <br /> DISTANCE TO NEAREST WELL. R FOUNDATION tl PROPERTY LINE ft <br /> ❑ SUMPS WlnTil ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION H PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH_11 LENGTH H DEPTH It <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> SEEPAGE PITS NUMBERWIDTN_ R DEPTH ft <br /> DISTANCE TO N.AREST WELL F0"N.A1I.N ��O R PROPERTY LINE ft <br /> 1 HEREBY CE.RTIFYTHAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL DE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> //.nn.((''� / .�I MUhl 24 IUH AD ANCE TIC/E EQ IRED FOR INSPECT )NS-PLEASE CALL(209)953-7697 <br /> /..� <br /> SIGNED 'c'�/ TITLE DATE <br /> L . <br /> i <br /> � L <br /> • 3 <br /> L <br /> f <br /> r <br /> jC r\O N <br /> NWE NT Jr <br /> e <br /> -- DEPARTMENT .'E O Y <br /> Application Acceple '—Date C1 Area Employee IDN "1 <br /> Final InspectionDate C) SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep of 3 Ft:- Pit/Sump Sall Character: <br /> COMMENTS <br /> PE SC Received Checldl Amount Date PermlU Invoice Permit IDN <br /> Code INFO B ■s Remllled Service Request N <br /> 2 e -73 SZ% d o 5 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> I JRJROOJ <br />