Laserfiche WebLink
5;0-0 <br />• ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 - (209) 468-3420 <br />JOB ADDRESS ` 4 /15 / 1 — iI p _ CITfYIZIIP bIyo"+611 !V z_ <br />CROSSSTREET nn r�/� APN ��� flS - 0 9 PARCEL SIZE_ <br />OWNER NAME IC Gi �'`�{'� � �y CA2 (�'(j .. PHONE <br />9(05 �ra�is (fid Sfl�n C-1 95z/S <br />OWNER ADDRESS [- / 1'CITYATATE/ZIP <br />CONTRACTOR 1yLt-\ rS -cg p{- yr PHONE D�C6G S '75--& . <br />CONTRACTOR ADDRESS 11 yi(2Y�^y LO C • CITY/STATE/ZIP yr ty 44•-et� [f � / <br />LICENSE ❑ C-42 ❑ C-36 OTHER (f4 NUMBEREXPIRATION DATE <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑. PERC TEST # <br />BUILDING PERMIT LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION , •' LI - . REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />• <br />O REPLACEMENT ❑ DESTRUCTION: I <br />INSTALLATION WILL SERVE: k6lbENCE ❑ COMMERCIAL(' ❑ OTHER' <br />OF LIVING UMTS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />/NUMBER <br />Il' SEPTIC TANK <br />TYPE/MFG I" d'L t CAPACITY �,a. 7 o gal #OFCOMPARTMENTS <br />❑ GREASE TRAP <br />TYPEMIFG tAPACrI'Y gal # OF COMPARTMENTS <br />• <br />DISTANCE TO NEAREST: WELL ft • FOUNDATION . fl PROPERTY LINE ft <br />❑ LIFT STATION <br />SYSTEM) <br />SIZE I "' TYPE OF PUMP' " ' ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR)) <br />EACH LINES <br />(ENCLOSED <br />O LEACHING CHAMBERS ... • •# OF LTNEs LENGTH`OF LINES <br />' DISTANCE TO NEAREST WELL {� R FOUNDATION ! I R PROPFRTY LINE <br />1 . <br />fi <br />❑ FILTER BED <br />,'WIDTH ft LENGTH ft DEPTH <br />,DISTANCE <br />ft <br />TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />R <br />❑ MOUNDED <br />WIDTH ft LENGTH ft DEPTH <br />ft <br />_ <br />DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE <br />fi <br />❑ SUMPS <br />WIDTH ft LENGTH ft MPTH <br />ft , <br />DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ' <br />ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br />ft <br />• <br />DISTANCE TO NEAREST WELL ft FOUNDATION ftPROPERTY LME <br />ft <br />SEEPAGE PITS <br />NuMaER WIDTH 3 4 It ft "Dmk )--157'1 <br />ft <br />DISTANCE TO NEAREST WELL I nfil ft FOUNDATION - i A I � ft PROPERTYLINE <br />'R <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION�AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMIJM 24 HH -OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 Q <br />SIGNED <br />t„r'--� TITLE/'�•r f3Li4 -'POe— <br />WO <br />DATE u 0 <br />WEEN <br />EM®ME <br />"!Area' F 'Employee ID; 3, <br />p f ' ❑ SPECIAL, PERMIT - Approved by-1��, - �{ <br />Pit/Sump Soil Character: ... _ •!'=-,' <br />PE I SC _ Rcceivcd L. <br />Coodee NFO By <br />Y/ l 1 1 1 1 (r I v1-- <br />' Date' I Permit/ <br />`. Invoice # Permit ID# <br />42-01 ONSITE WASTEWATER PERMIT <br />ncn nl <br />D <br />