Laserfiche WebLink
~ �}� ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET- STOCKTON CA 95202.(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 9S3-7697 FOR INSPECTIONS EXP{RES I YEAR FROM DATE ISSUED <br />JOBADDRESS _ � -5 i" ( y �_ o S' -`"" 51E CITv/zIP _�✓''+-�'.z� <br />CROSS STREET APN S s L'C'— �L^ PARCEL SIZE u� <br />OWNER NAME 'aG{ i'►'L C.'J I ✓C' 1 f PHONE C� <br />OWNER ADDRESS �I `Z / Cv. .zip ,_ /('.:� L .1._ _ CITYISTAT'EEIZIP q t `�"Tj'�' c Al. 7 G 6 <br />CONTRACTOR) IS tl :p1.,� (l` �L's� ..,_... PHONE `� l � Z.�/'/-��'^ <br />CONTRACTOR ADDRESS CITYISTATEMP IJr ``J —f ✓� <br />LICENSE R C-42 ❑ C-36 OTHER __. �r NUMBER �S EXPIRATION DATE <br />WATER TABLE DEPTH: <br />_ Sl GEOGRAPMCAL INFORMATION: C00rdinAtes 7( <br />Y_ <br />❑ PERC TEST k _ <br />BUILDING PERMIT # <br />-- 07040 O LAND USE APPLICATION #_...,___ <br />TYPE OF WORK: <br />NEW INSTALLATION l3 <br />REPAIWADDITION <br />O ENGINEER DESIGNEDlALTERNATSVE'IVEJJ <br />Q REPLACEMENT _ <br />O DESTRUCTION <br />INSTALLATION WILL SERVE: RFSIDEN <br />❑ COMMERCIAL <br />❑ OTHER <br />(- <br />NUMBER OF LTVING UNITS:N ER F BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTTCTANK <br />TYPEIMFG_ <br />CAPACITY <br />pi N OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG_ t <br />CAPACITY <br />gal # OF COMPARTMEN M <br />DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE <br />DISTANCE 'IONEAREST: WFLL_ __ <br />_ ft FOUNDATION_— <br />ft PR OFERTYLRYE ft <br />❑ LIFT STATION <br />SIZE _ ________ TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />A LEACHING CHAMBERS # OF LINES LENGTH OF LINES <br />DISTANCE TO NEAREST N S /L� fl FOUNDATION R PROPERTY LANE if_ <br />❑ FILTER BED <br />WmfH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL _ ft FOUNDATION R PROPERTY LINE. <br />❑ MOUNDED <br />WIDTH ft LENGTH ft DEPTH <br />DISTANCE To (NEAREST WELL R FOUNDATION ft PROPERTY LINE <br />R <br />O SUMPS <br />WmTR It LENGTH _ ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL _ ft FOUNDATAN ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS <br />WIDTH ft LENGTH_ ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE <br />A <br />❑ SEEPAGEPITS <br />NUMBER WIDTH_ ft DEPTH <br />fl <br />DISTANCE TO NEAREST WELL ft GOCNDATION fl PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND TiM WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />4 HO ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 933-7697 <br />cici I�LQ_ ✓r <br />SIGNED�I <br />TITLE_ C7 DATE <br />LA <br />=a <br />J DEPARTMENT 1jSF ONLY <br />Application Acceptsd By 1/� Date Arca EnV1oycc ID1t <br />Final Inspection By � �.G• Date y ., 13 SPECIAL PERMIT -Approval by <br />Character of Suit to Depth hoor, 11 Ft: _ P" ump Sail Character: <br />COMM_PiTS ticE 4E.c, ,� _/ /_-1. PLA.'o-s6 <br />i. 1. _F—l2 g . <br />1 <br />I <br />PE SC i&eiYI ved k.Chee Amount Date <br />Code ! iNTo Ry Cash Remitted ,1 <br />42-1ffi K fs` 1�`'�i�%so•C- $J <br />42-01 ONSITE WASTEWATER PERM IT <br />05130%2007 <br />