Laserfiche WebLink
- ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3H°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209/953-7697 FOR INSPECTIONS EXPI/RJESS I YEAR FROM DATE ISSUED <br /> JOB.ADDRESS ��S ���1�-µ-/CCTx=! T /�L4F CITY/ZIP I p �_ y <br /> CROSSSTREET �� + /v��I APN �q I �r V PARCELySIZJE g� � p <br /> OWNER NAME �fk�c/Z7,1 _._ ,r 1 k/ rJ_ PHONE � J <br /> OWNER ADDRESS 9&Z eAZ+T/CTf / f-L CITY/STATE/TIP 7 -4JC/yy-, LjI`�`y[ �1723o <br /> CONTRACTOR PHON psca fJ / -U✓ 7o <br /> CONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER !l EXPIRATION DATE <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# [�� pQ,�T7 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ,/ L3 OTHER <br /> NUMBEROFLIVINGUNITS: f NUMBER OF BEDROOMS: !Z NumarnofEMPLOYEES. <br /> Q <br /> SEPTIC TANK TYPE/MFG ���C. CAPACITY l0a gal #OF COMPARTMENTS Iz— <br /> /❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE To NEAREST: WELL, t O V ft FOUNDATION !_57— ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> /fly' LEACH LINES Ll LEACHING CHAMBERS #OF LINES LENGTH OF LINES _ �O�Uq ft <br /> DISTANCE TO NEAREST WELL C2 <-'S ft FOUNDATION ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> F DISTANCE To NEAREST WELL ft FOUNDKI'ICN ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTI4 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> HEREBY CERTIFY THAT 1 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 /> M NIMUM 24 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE C ,L(209)953-7697 <br /> SIGNED TITLE: DATE 6 <br /> I H <br /> LL <br /> T <br /> 3 ' <br /> I <br /> k I <br /> Q y c _ <br /> M t3 <br /> N <br /> t <br /> DEPARTMENT US ONL <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection Ey Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil toepth of 3 Ft: APitlSu mp Soil Character: <br /> COMMENTS <br /> PF SC Received heck#! Amount Date Permit/ Invoice# Permit[D# <br /> Gude INFO B Remitted Service Re # <br /> X31b 1� !z n o <br /> S ob ©347 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12!22/2003 <br /> r <br />