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 <br /> PPEyER��M,,IT IL <br /> y� CALL 209 95pp3-�7697 FOR INSPECTIONS EXPIRES 1 ppYEAR FROM DATE ISSUED <br /> JOB ADDRESS '�3Gf�� L! L �-S D1°C LE 1"'✓• CRY/AP AC-A MIP 0 7 5' Z0 ti <br /> CROSS STREET f 1�" 9 1 E• T�`"""' EAPN •� p '` -�,- �-�3 ; . <br /> �I�1'D[0'T�'. -i_�t .tic'.L�.�,PARCEL SIZE 14-. b <br /> ^ e <br /> OWNER NAME C►'ywr021111 A LONG' f�-Yt l L �'0' PHONE <br /> N <br /> OWNER ADDRESS 19(off s- /V CITY/STAE <br /> T21P A G/tm Pa a&\p,. -/a s 2 -O <br /> CONTRACTOR L-I 1(E jC)PIry— &E o rVl2d 's'I E�tt�- PHONE 3 LOC' 0.3 <br /> CONTRACTOR ADDRESS " "7 w ' 91TN-- CITY/STATEMP (-0D <br /> LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> !LT PERC TEST #__L_ FFIJITDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDIMON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LMNG UNRS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY 921 #OFCOMPARTMENTS <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 PLANT ❑ 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 R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELLft 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 ft <br /> DISTANCE TO NEAREST WELLft 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 /> MINIMUM R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 C <br /> SIGNED / TITLE C&A/sdL71 4AJT- DATE <br /> (- -- 1 i'">11 1777-'! <br /> RECEIVED <br /> �` °ir/ �- �'_�I ��3 �r " h - 1 2015 <br /> JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> -z_ EALTH DEPARTMENT <br /> SITE PLAN <br /> PARTMENTUSE NLY ��(y? <br /> Application Accepted By Date 3 Area•±•I—-`L Employee ID# �l 1 tX- <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 I CAWjdA­' Amount PermiU <br /> Code INFO Cash Remitted Date Servic Re uest# Invoice# Permit ID# <br /> L�l7 i7 121'it I S <br /> 42-0t ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />