Laserfiche WebLink
i <br /> L)AJ1lL1 WAN lEWA lEK 1KEAI1VILAl .�YJ1Lin r)L.K1Vui <br /> ,SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3NO FL-STOCKTON CA 95202-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 33 ()_..2 tl �+ I)CII I J ICS' CITY/ZIP )''T �!e41/� <br /> CROSS STREET l 13 2- APN ZSs E}q J PARCEL SIZE �� p <br /> OWNER NAME 1 Cyl 1 Be IST 'PH`ONE <br /> OWNERADDRESS 16 1 CC ItW,• I' By r0 h Rj__ _ CITY/STATE/ZIP /rQ Gh <br /> CONTRACTOR Det) Lu VU ` R PHONE i <br /> yW <br /> CONTRACTOR ADDRESS <br /> --Li)0 Loom;� `� CITY/STATE/ZIP C K 1 V.1 C?G+ <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# C`^ <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS 4l <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft `• <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 /> MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE Gs•`E3 <br /> r <br /> r <br /> A T1 <br /> %PARTMENT USE ONLY <br /> Application Accepted By OK yy,n Date _ . Area_�L Employee ID# 14s6 <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PitlSump Soil Character: <br /> CO MENTS - <br /> PE SC Received Ch k#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B sh Remitted Service R u t# <br /> ti n3 CSR 003 4-0 <br /> 42-01.001 ONSITE WASTEWATER PERMIT <br /> 12/2102 <br />