Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS ExPPIRES 1 YEAR FROM DATE ISSUED <br /> JOSADDRESS ✓ _ 43 Z11) i••1" �— CITYIZIP 1~� .q 1c � � <br /> ,. / 6"-?— —( ) f <br /> CROSS STREET �✓ / L I, r%OL71'Ti r APN � 1 PARCEL SIZE <br /> PHONE <br /> OWNER NAMff ! <br /> OWNER ADDRESS <br /> `7 ✓i��.17•',� CiTYISTATE/ZiPP'�` <br /> s _ <br /> rar 7 p'/ C ? PHONE L'7 1'1 1 32 <br /> CONTRACTOR � ,� ---y ,/ •� �,✓ x <br /> CONTRACTOR ADoftEsss �v ✓ CITYISTATEIZIP <br /> LICENSE CC-429C'38 OTHER J4,8 Z NUµaEREXPIRATiON DATE <br /> WATER TABLE DEPTH• GEOGRAPHICAL INFORMATION; Coordinates X Y <br /> Q1 FERC TEST # BUILDING PERMIT# ......._ LAND USE APPLICATION# <br /> REPAIRIADDR <br /> TYPE OF WORK: L; NEW INSTALLATION i ION 0 ENGINEER DESIGNED}ALTE�RN,ATTIVE <br /> 0 REPLACEMENT l: OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ("I RESIDENCE 1.1 COMMERCIAL r. OTHER <br /> NUMSER OF Li mo UNITS: NUMBER OF BEDROOMS: NuMBrzR OF EMPLOYEE3; <br /> © SSPTIC TANK TYPEIMFG CAPACITY 981 #OF COMPARTMENTS � <br /> 0 GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br /> LI LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES C. LEACHING CHAMBERS #OF LINES LENGTH OF LINES fit <br /> DirsTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> (3 FILTER BED WIDTIA It LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE---ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> © DISPOSAL PONDS Wim ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER, WIDTH ft DEPTH <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 /> MIIYJMU '0l kE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20,91953-7697 <br /> SIGNED ";T"/' TITLE Ca�.�` /q ! DATE <br /> Jv <br /> i <br /> 1 <br /> i <br /> i <br /> i I <br /> ��. - _`bE'PA TM EN TP ONLY <br />