Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HCALTH DEPARTMENT 600 E MAIN SlR6@T-STOCKTON CA 95202-(208)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS ����'F' S� C1 0G -rS 9-D. CITYlLPC'rV64"-1-07'J 9F P <br /> CR033 STREET a-,1I't wAT—0 APN L!'�' IITV 03 PARCEL SIZE ���•S A-C <br /> -fi <br /> OWNER NAME r'C-x�oi�'N Cwt tV PHONE <br /> �0) Z-). 17 IGQ I� <br /> OWNER ADDRESS 3314 Gf-Serg- C FT` ,7 V GZ ST- CITYISTAT£1LP S^� TP-A"-J jC0 CA g4110 Li <br /> CONTRACTOR 1-(VC Ot'\V- �'tU�1✓I(zor./r+9C�PiL PHONE 31-0)1 03-19'- <br /> CONTRACTOR <br /> 15CONTRACTOR ADDRESS ff!2-1 V)- 0 CITY/STATE/ZIP "DI t C-A 'I S-I q C7 <br /> LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST #____L_ BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION 0 REPAIR/AODITION ❑ 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 /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATIaN SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL It FOUNDATION fl PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLfl FOUNDATION fl PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH fl <br /> DISTANCE TO NEAREST WELLft FOUNDATION fl PROPERTY LINE It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 /> MINIMUMS 4WUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED /` TITLE t-OWJ✓9-Ty'^1T DATE -20 <br /> Ec SENT <br /> ���ED <br /> PR 23 ZD20 <br /> RONM COUN <br /> T oFPq R� ANT <br /> I <br /> Application Accepted By /G' C/ DEPADate '4T <br /> 4- 23 2 a zO Area—3Z'// Employee ID# DA <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character; <br /> COMMENTS <br /> PE SC Received Chac Amount Date Permit/ Irwoice# PermitlD# <br /> Code INFO sh Remitted Service Re uest# <br /> Ljvo !was D Ise .91UP OO <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />