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 CALL 209 953-7697 FOR INSPECTIONS 1 YEAR FROM JUTE ISSUED <br /> JOB ADDRESS I CITY/Zip LA <br /> CROSS STREET APN CYtJ r O`'V��� PARCEL SIZE 0.7� 4-G D <br /> OWNER NAME v HJI� Il rJl �GYC�/_/IALV�L�rCJ .P -73 3 l-33 <br /> OWNER ADDRESS CITYISTATE/ZIP, <br /> CONTRACTORkjaijiML) PHONE3LO -),7 <br /> CONTRACTOR ADDRESS ro r,n CITY/STATFJZI <br /> LICENSE ❑C-42 ❑C-36 OTHER rr NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: fl GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # I I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAI DDMON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> Q---REPLACEMENTESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: ,,,� [NNUUMBER OF BEDROOMS: / Q NUMBER OF EMPLOYEES: <br /> I <br /> U-- CTANK TYPE/MFG COX4 C�'Er CAPACITY L D-0 gal #OFCOMPARTMENTS 2— <br /> U. <br /> - <br /> ❑. GREASE TRAP TYPFJMFG CAPACITY gal #OF COMPARTMENTS <br /> Ic64G aa.s.... <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL 100 fl FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ®;,❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 13LEACHING CHAMBERS Nd F IG L NES LENGTH OF LINES fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH - It C <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH 0R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH R DEPTH R <br /> DISTANCETONEAREST WELL fl FOUNDATION ft PROPERTY LINE R <br /> SEEP NUMBER WIDTH 1 No" R DEPTH 2-5 <br /> DISTANCE TO NEAREST WELL Y-IDO R FOUNDATION R PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY 1 <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> h IN UI1 4 f UR ADVANCE NOTICE REQUIRED FOR INSP CTIONS,�I �SEq�A LL(2009)953-7697 <br /> SIGNED TITLE lfl�//�') / DATE —[O <br /> L <br /> SAV I <br /> He <br /> iR <br /> 74 le <br /> EP <br /> • DEPARTMEN'T!U EO Ly <br /> Application Accepted By_ Date T ` (o Area Employee ID# Sq� c7Q <br /> Final Inspection By _ Date J ❑ SPECIAL PERMIT-Approved by <br /> Character of Soll to IDA- PI ump SoH Character: <br /> COM MENTS SFO7-1 C- 7-74-y V-' tic cc.s T- A E Wr- L-F-A-&-r I(W FT F:12o A-f 77f E o---(7"E /u6 u L <br /> W EC.L- <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted Service Request# <br /> c�2-Is is ►� 1 '1 4sb,,-O 1410166 Z160 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12222003 <br />