Laserfiche WebLink
119A 40 <br /> s ONSITE WASTEWATER TREATMENT SYSTEM PERMI <br /> 1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTON CA 95202-(209)469-3420. <br /> jNON-REFUND'ABL'E PERMIT �t UGYi' CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> t JOB ADDRESS ...CITY/ZIP ''' y <br /> CROSSSTREET APN b �� PARCEL SIZE CO o <br /> A <br /> d )� � PHONE <br /> OWNER NAME -4 il1,1`� f� � Yn' <br /> OWNERADDRESS 57- S--921-- CITY/STATE/ZIP' <br /> CONTRACTOR "G PHON <br /> 46-01 <br /> CONTRACTOR ADDRESS. CITY/STATE/LIP- - <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> c ❑ PERC TEST # ` BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION O ENGINEER DESIGNED/ALTERNATIVE <br /> • ❑"' REPLACEMENT ❑ DESTRUCTION I <br /> fINSTALLATION WILL SERVE: CK RESIDENCE _ ❑ COMMERCIA ❑ OTHER <br /> gyp NUMBEROF LIVING UNITS: NUMBER OF BED MS: - _NUMBER OF EMPLOYEES: <br /> yp�SEPTIC TANK TYPE/MFG CAPACITY !ice gal #OF COMPARTMENTS 2- <br /> C' /❑ GREASE TRAP TYPE/MFG a•. I CAPACITY, gal` #OF COMPARTMENTS <br /> ' ❑ PKG TX PLANT DISTANCE TO NEAREST:' WELL 4 t'VLRt FOUNDATION " ft PROPERTY LME - -• ftF <br /> + ❑ LIFT STATION SIZE _TYPE OF PUMP ❑_ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> t <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES I LENGTH SOF LINES ft ; <br /> }i F:? <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft .PROPERTYLINE ft _,,-I_ ILTER BED WIDTH <br /> ft LENGTH R DEPTH' If R <br /> DISTANCE TO NEAREST WELLALA— FOUNDATION D ft PROPERTY[.INE ft <br /> ❑ MOUNDED WIDTH ft LEND ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft ' LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Rl,' <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It. DEPTH ft �tyL <br /> DISTANCETONEARESTI• WELL R FOUNDATION. ft PROPERTY LINE R; Tail; <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH - Rlvl�1' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R1: :;•�'I' <br /> ' t'J <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY• <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 'I <br /> •� MINIMUM 24 HOUR 1i ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 • ) '}`` <br /> SIGNED l TITLE C'ACA DATE �. Q <br /> -01 <br /> f <br /> A es xETw siAe ewceca�s �wrwtru -- -- - - -- <br /> .,,Y .,. sa P+IaataasDOnros+iw <br /> !.. (�)Dw Yl: <br /> (E)MAIN <br /> , <br /> V. <br /> U � mtoeY�Ioso�rnrr.ca � 'ilea. <br /> I. n <br /> : a <br /> i________-__ (Fa1TER BED, .. <br /> a !,a) DPAYMENT <br /> oMt,l, e' T' <br /> la I ,a...t RECEIVED <br /> ��_ --_-- a -- - <br /> - <br /> MAR 19 200T, : <br /> SAN JOACUM COU, <br /> ENVI.R..QNMENTA <br /> Q Q <br /> Application Accepted By Date d Area Employee ID# <br /> Final Inspection B Date st ❑ SPECIAL PERMIT-Approved by <br /> Character of Sol]to De of 3 - Pit/Surpp Soil Chan er. <br /> COMMENTS A <br /> I PE SC Received Amount - - Date Permit) �,do► U <br /> Code . INFO By Cash Remitted Service R asci# <br /> i 42-02-001 X �-(' ff ONSITE WASTEWA 'RMIT C' <br /> • 12222003�7•_��''�'��,T�o�iil�/c�G!7�/.7�G'rrt'i• y���')_Y'+�, <br />