Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTALHEALTH DEPARTMENT 600 E MAIN STREET -STOCKTON CA 95202 -(209)468-3420 <br />CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS __......L -=~~..!..:..~.....:..:.....:..LL.---------CITYIZIP__~!.!t"A!:!...~~~_ <br />12-PARCEL SIZECROSSSTREET_~~~~~~APN 2.?I·I~>oo::umC/I!'! <br />D PERC TEST #I BUILDING PERMIT #LAND USE APPLICATION # <br />L;TY~P~E;O~F~W:';O:;R~K~:-=-=:;O==::;N:::::EW:::::::;:IN:::S~T:::A:""'LLATION REPAIR/ADDITION u ENGINEERDESIGNEDIAL TERNATIVE <br />o REPLACEMENT <br />OWNERNAME_~~~_~~~~~PHONE _ <br />OWNER ADDRESS CITY/STATEIZIP <br />LICENSE DC-42 DC-36 OTHER_~_NUMBER --,....:...;:o....::..:'-=-----,_EXPIRATIONDATE ---.:~:...:.=_==-+-=---.:.._ <br />CONTRACTOR ~~~~~~~~~~~~----~--------PHONE ~~~~_~~_ <br />CONTRACTORADDRESS _.....:........:.......:....=-_...:........:.....~:..:..:......:...:.....:..::..;,._---.:~_=_CITY/STATEIZIP --J-...::....:.;:.....:=-:....:'-'::-'~..:...:.,,-----.:.......;;_;:....;'--"--_ <br />WATER TABLE DEPTH:ft GEOGRAPHICAL INFORMATION:Coordinates X Y <br />L DESTRUCTION <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />El RESIDENCE D COMMERCIAL <br />NUMBER OF BEDROOMS: <br />D OTHER _ <br />NUMBER OF EMPLOYEES: <br />[J SEPTIC TANK <br />[J GREASE TRAP <br />TYP~MFG _ <br />TYP~MFG _ <br />DISTANCE TO NEAREST:WELL _ <br />CAPACITY _ <br />CAPACITY _ <br />ft FOUNDATION _ <br />SIZE TYPE OF PUMP [J PKG TX PLANT <br />gal #OF COMPARTMENTS _ <br />gal #OF COMPARTMENTS _ <br />ft PROPERTYLINE ft <br />[J SAND OIL SEPARATOR (ENCLOSED SYSTEM)[J LIFT STATION <br />[J LEACH LINES g LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br />[J FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br />[J MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br />[J SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br />[J DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br />[J SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE 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 />A"DVANCE NOTICE REQUIRED FOR INSPECTIONS·PLEASE CALL (209)953-7697 <br />TITLE ,,/DATE _":,,,(~_-,-__CJ_SIGNED ~~_---- <br />\ <br />"'}V~~~y <br />;"'1 \tt-P- <br />)1')II-' <br />~r-<,I-V 1'9 ,I h b I <br />!l '1 If'-~ <br />IL,IX.~SP \I'Y'1-- <br />\rt--, <br />1·-. <br />,. <br />t'h 'C •••-I..! <br />~A ~,1U I...r.vICI~ <br />I ,-~rJ l U~:,10 11 ~ntla <br />••II-J)!p."r ISA r.."'""lA h.\.~VI 11-1<~'Y.rrA ONI tiEr tr~!'Ii <br />In "::VI I <br />"V IMt f '-vrt I <br />DEPARTMENT USE ON~Y (,..J..5"~~ <br />Application Accepted ~~Date Area Employee ID#!e,I <br />Final Inspection By::';?4~ok ~--'<.----,7'-....,.c.,~r--0 SPECIAL PERMIT -Approved by _ <br />Character of Soil to Depth of 3 Ft:~Soil Character:--'-_ <br />COMMENTS 0' <br />PE SC Received Check#!Amount Date Permit!Invoice #Permit 10#Code INFO By Cash Remitted Service Request # <br />./ <br />42-01 <br />10/4/07 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT