Laserfiche WebLink
1k)—_ 3.31` -5 r'4A 5L"" `1- v0b 05x1 <br /> 0' z(=-30 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUND P MI CAL 953-7697 FOR INSPECTIONS E PIRES 1 YEAR FR TE ISSUED <br /> JOB ADDRESSTO <br /> WW: /C{� /ZIP <br /> �/ <br /> CROSS STREET ItoAPN �I L.rW I PA10 qRC L SIZE <br /> O <br /> O <br /> OWNER NAM A e _ PHONE <br /> OWNER ADDRE '�+ ' CITY/STATE21P O l_I� <br /> CONTRACTOR HONE <br /> CONTRACTOR ADDRESS&O Ma&Mi <br /> LICENSE �(C-42 .l C-36 0'­ NUMBERtIM91 EXPIRATION DATE_ Lt <br /> 1177 <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> U PERC TEST # BUILDING PERMIT# /(_b LAND USE APPLICATION# <br /> TYPE OF WORK: - NEW INSTALLATION REPAI AD ENGINEER DESIGNED/ALTERNATNE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE U COMM C OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEOROGMS: NUMBER OF EMPLOYEES:___ <br /> SEPTIC TANK TYPE/MFG I?;, CAPACITY gal #OF COMPARTMENTS... <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENT <br /> DISTANCE TO NEAREST: WELL _ It FOt1NOATION It PROPERTY LINE L ' It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> JQ LEACH LINES a( LEACHING CHAMBERS ;iO #OF LINES r LENGTH OF LINES k <br /> t <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY UNE it <br /> ❑ FILTER BED WIDTH ft LENGTH it DEPTH N <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY UNE it <br /> ❑ MOUNDED WIDTH it LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL-_ n FOUNDATION it PROPERTY LINE it <br /> ❑ SUMPS WIDTH it LENGTH __ ft DEPTH it <br /> DISTANCE TO NEAREST WELL . it FOUNDATION_ it PROPERTY UNE it <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH _ it DEPTH it <br /> DISTANCE TO NEAREST WELL __ it FOUNDATION ft PROPERTY UNE it <br /> Pi SEEPAGE PITS NUMBER I WIDTH_.- <br /> o N DEPTH _ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION it 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 /> k�M�l�;J{1 HOdR A *&�T�. aTT}G�EI�HEQUIRED FOR 1103QKT10ASE CALL 209 953-76,9 <br /> SIGNED ��/ V LXT'-j-'� TITLE DATE , <br /> 7100L. <br /> � <br /> dr <br /> 4 CLI <br /> �r DEPARTMENT USE L <br /> Application Accepted B lti' Date Area v� R� Employee ID# Z s�tk <br /> Final Inspection B Date l� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De of 3 Ft: _ Pit/Sump Soil Character: <br /> COMMENTSLdt- � <br /> -� - <br /> PE SC Received Check#/ Amount Date Permit/ Invoice If Permit ID# <br /> Code INFO By Cash Remitte Service Request# <br /> LAIJID L1G 5'171 SE 75tUp <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />