Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMITfi <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"°FL-STOCKTON CA' 520 ".(2t�)f46$-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953/--7697 FOR ONSPECTIO.NS EXPIRES 1 YEAR FROM DATE ISSUED <br /> G <br /> JOB ADDRESS �7L�lir':. "'. ! �r y <br /> tl�c CITY/ZIP e.��s —`-"-�� <br /> , A Ll I'►1 f'U X95 z ZZ ,. _ � <br /> CROSS STREET l"7ItI j °! APN _I '0 /Lim 2 PARCEL SIZE � �� !j e' C <br /> OWNER NAME �' l'; (+L 2. �t� Q �9 4��t/� m <br /> PHONE m <br /> t� ti <br /> OWNER ADDRESS q�� ' 1�'!cry 4"/19:/Ze- CITY/STATE/ZIP Icel <br /> CONTRACTOR 56:. (I'S&.4 ic' �e s'�r G''1 PHONE 7 �et y.' 6 <br /> CONTRACTOR ADDRESS6' Y.2•�L t CITY/STATE/ZIP <br /> LICENSE ❑C42 ❑C-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 C❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT DESTRUCTIONIL-XI S►Z n.(�- 7n (C, <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: y NUMBER OF BEDROOMS: --T NUMBER OF EMPLOYEES: A <br /> SEPTIC TANK TYPE/MFG L CAPACITY �`'�t, gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY. gal #OF COM PARTMENTS G <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft j t• <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> C LEACH LINES ❑ LEACHING CHAMBERS �L) -uhr�s #OF LINES LENGTH OF LINES -416 <br /> DISTANCE TO NEAREST WELL 'fl FOUNDATION fl PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL f[ FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH fl <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 Y c• ft DEPTH --,2 ft <br /> DISTANCE TO NEAREST WELL 100 /V-1-11 FOUNDATION fl 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 <br /> /��� � ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED <br /> MINIMUM.jGam24 HOUR ADVANCE NOTICE REQUIRED FORINSPECTIONS-PLEASE CALL(209)953-7697 l <br /> TITLE � DATE <br /> a <br /> JI <br /> (a <br /> 1 Y i <br /> Y►v <br /> ,c Lu JU <br /> r Y <br /> N L _ <br />