Laserfiche WebLink
f(m <br />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) 953-7697 FOR INSPECTIONS ExPjRESA YSM FROM DATE ISSUED <br />JOB ADDRESS gE�1 4 E po��� CITY21P _ <br />CROSSSTREET– APN CYC 3-0so— 19 PARCEL SIZE +•✓' - J <br />OWNERNAME G PHONE 1,2 <br />•fes . .�5�/� <br />OWNER ADDRESS CI7YISTA7EIZIP <br />CONTRACTOR _ 51if1R(–iPS1C- d I 1 TIJ�) PHONE 2'�ifapl-Zr�SSZ /4 7 /� IS 3Z <br />CONTRACTOR ADDRESS o610 i �. C-i(,l,-t.C.T] �JG, �'t0 � CmISTATEIZIP L-000 <br />LICENSE VC -42 ❑C-36 OTHER NUMBER _7595ft8 EXPIRATION DATE OZ.)ZSjos <br />WATER TABLE DEPTH:_ It GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ <br />PERC TEST III —� BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: _ NEW INSTALLATION REPAiR/ADDITIDN 1 ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT DESTRUCTION <br />INSTALLATION WILL SERVE: J( RESIDENCE ❑ COMMERCIAL :j OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ <br />SEPTIC TANK TYPEIMFG CAPACITY gel # OF COMPARTMENTS <br />❑ <br />GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br />DISTANCE TO NEAREt'T: WELL ft FOUNDATION _ ft PROPERTY LINE It <br />U <br />LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT LI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />13 <br />LEACH LINES F <br />LEACHING C�r� #OF LINES —� LENGTH OF LINES �T k <br />DISTANCE TO NEAREST WELL IUOT ft FOUNDATION 40' ft PROPERTY LINE <br />17 <br />FILTER BED WIDTH It LENGTH 1—ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE ft <br />❑ <br />MOUNDED WIDTH ft LENGTH It DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />O <br />SUMPS WIDTH ft LENGTH _ ft DEPTH _ --ft <br />�ft <br />DISTANCE TO NEAREST WELL —ft FOUNDAT.ON It PROPERTY LINE <br />❑ <br />DISPOSAL PONDS WIDTH It LENGTH It DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br />g <br />SEEPAGE PITS NUMBER 2- WIDTH 1�56" ft DEPTH 'LS' ft <br />DISTANCE To NEAREST WELL 1 ft FOUNDATION SO` rt PROPERTY LINE 'jo, 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 />INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 933-7697 <br />SIGNED- TITLE • DATE i Di <br />,DEPARTMENT USE ONLY��+ �'r <br />Application Aa - Date : c�—C.� Area Employee ;D# <br />Final Inspection B , Date 1�//(J ❑ SPECIAL PERMIT -Approved by <br />Character Of Soil teDep of 3 Ft: PI Sump Soil Character: <br />COMMENTS <br />PE SC Received eck#1' Amount Date Permit/invoice # Permit IOAI <br />Code INFO Remitted Service uoet # <br />S9 <br />42-01 ONSITE WASTEWATER TRT&WT SYSTEM PERMIT <br />10/4107 <br />S <br />1W <br />S� <br />a <br />