Laserfiche WebLink
t <br /> .ONSITE WASTEWATER TREATMENT SYSTEM PERMIT i j ►i� 1 v <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVLNUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS_LQ-p'g- e• CITY/ZIP <br /> -- " 6 ZZ <br /> CROSS STREET �9-33 --! <br /> APN_ PARCEL 5=2E <br /> 0 <br /> OWNER NAME _ PHONE -� z <br /> OWNER ADDRESS rte./ --- ---CITYiSTATEiZIP ___- -,r Tp CONTRACTOR ���� _ PHONE r� I <br /> CONTRACTOR ADDRESS _i1JV>,�� I S� .___ CtTYISTATE011 <br /> 1 —, ^ <br /> LICENSE � C-42 1 I C-36 OTHER__2 n NUMBER S EXPIRATION DATE �^..I_ <br /> K `s —085 <br /> WATER TABLE DEPTH: _ It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I 1 PERC TEST # BUILDING PERMIT# P�-43VLAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE i I COMMERCIAL 1 1 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: W041%0+1 <br /> ���� _ NUMBER OF EMPLOYEES: <br /> SEPTIC TANK)TYPE/MFG CAPACITY W041^'Q+ gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG .__ CAPACITY - gal #OF COMPARTMENTS_ <br /> DISTANCE TO NEAR ST: WELL FOUNDATION ,. it PROPERTY LINE <br /> LIFT STATION CEJ) SIZE 150 TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINESLENGTH OFLINES +✓_ ft <br /> DISTANCE TO NEAREST WELLf�!lJ -it FOUNDATION _.___it PROPERTY LINE R <br /> ❑ FILTER BED WIDTH —it LENGTH _ it DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION __it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH it LENGTH__ it DEPTH it <br /> DISTANCE TO NEAREST WELL __ it FOUNDATION it PROPERTY LINE K <br /> ❑ SUMPS WIDTH it LENGTH________ it DEPTH it <br /> DISTANCE TO NEAREST WELL _ FOUNDATION_ it PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH K LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL _ it FOUNDATION it PROPERTY LINE R <br /> ❑ SEEPAGE T NUMBER WIDTH _- it DEPTH it <br /> DISTA ONEAREST WELL _ it FOUNDATION it PROPERTY LINE_ fl <br /> [HERE CERTIFY AT AVE PREP RED THIS PPLICATION A THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE L WS AND RU S AND GULATIONS OF SA JOAQUIN COUNTY. <br /> 1N/MUM HOUR A NICE OTI RE 1 D F SP TIO -PL E CALL 209 903-76 <br /> SIGNED TITLE DATE <br /> Y <br /> a- <br /> 5 Y" <br /> ` <br /> PEPARTA1ENT SE ONL <br /> Application AccepteAp1hof <br /> ate Area � Emplcyee WDFinal Inspection By ❑ SPECIAL PERMIT-Approved byCharacter of Soil to I ump Soil Character: <br /> COMMENTS L <br /> Co �( lr <br /> PE SC Re-eived Check#/ Amount Permib' <br /> Code INFO B ! Cash Remitted Date Service Request# Invoice# Permit ID# <br /> 2 --Scvz <br /> i�_ <br /> 42.01 t3NSITE WASTE'P/ATEH TR'fMN SYSTEM PERMIT <br /> 4/24/12 <br />