Laserfiche WebLink
IftH <br /> g3d <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTO14 CA 95202.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE IS UED <br /> JOB ADDRESS1 CITVIZIP <br /> CROSS STREET DUA1[ APN PARCEL SIZE <br /> OWNER NAME W��,`y W �^'�^>> PHONE <br /> OWNER ADDRESS CIT1/STAT_E/ZIP <br /> CONTRACTOR PHONE <br /> &,&V- <br /> t G+uln Pn/C7 L03CITU/STATEZP I-�J �-A/1 C <br /> .� Q�S Z�i <br /> aCONTRACTOR ADDRESS <br /> LICENSE U-42 QC-36 OTHER NUMBER 7CG15q 8 <br /> EXPIRATION DATE �Z,�ZE31 tSj <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COO mates X F Y <br /> Fff .PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION CI REPAIR/ADDITION Ci ENGINEER DESIGNED/ALTERNATIVE <br /> CI REPLACEMENT 0 OUT-Or-SERVICE SEPTIC SYSTEM U DESTRUCTION <br /> INSTALLATION WILL SERVE: Fri RESIDENCE I I COMMERCIAL U OTHER <br /> NUMBER OF LF/WG UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY I;160 gal #OFCOMPARTMENTS `Z <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL SO'* R FOUNDATION 7-0/ ft PROPERTY LINE �'�'�1 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 9-LEACHING CHAMBERS #OF LINES LENGTH OF LINES bo r R <br /> DISTANCE TO NEAREST WELL SOIL R FOUNDATION 3O R PROPERTY LINE �� R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Ia SEEPAGE PITS NuMBER Z WIDTH L4 S •` ' ft DEPTH 2-IS7 1 ft <br /> DISTANCE TO NEAREST WELL I b O'-V R FOUNDATION R PROPERTY LINE L-4O r R <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 /> 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE - DATE !P O I./1(J(L <br /> O <br /> — - — <br /> El A R T M E N T If S E Jb N L Y <br /> Application Accepted By-,, Date Area Employee ION <br /> Final Inspection By <br /> i T a? Date _ O SPECIAL PERMIT-Approved by <br /> Character of Soil to Ojil of 3 Ft: PiUSump Soil Character: <br /> COMMENTS � � o jTT lIF <br /> PE <br /> -- � SC Rece _ Amount Date Permit/ Invoice# Permit[DO <br /> Cods INFO h Remitted Service Request# <br /> �1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 9/21110 <br />