Laserfiche WebLink
9� <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3YD FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT �jy CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ZI ! N t ' •`��N CITY/ZIP <br /> CROSS STREET Ca PP6jZ0 L;1:^S APN/CI 31t'OYQ PARCELSIZE <br /> OWNEHNAME NPrNDa �L IJL L_f� PHONE <br /> OWNER ADDRESS w- CI.1•Y/STATFJZiP <br /> COMRACrOR Cr G�-O�V��IJ♦�'',' p, /� x/N-,C PHONE�`_Z 5 <br /> CONTRACTORADDRESS ] N r .4J� rT`� 1��J «t Cffvff&rATTE/ZIP <br /> LICENSE ftC•42 ❑C-36 OTHER ,___, NUMBER_ {�-L,�FZ] EXPIRATION DATE_ <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINPORMATION; Coordinates x <br /> Y <br /> ❑ PERC TEST(S) NUMBL•R LAND USE APPLICATION# <br /> ^� <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DHSICNED/Ai.TEANATIVE <br /> O REPI.ACEMENT 13 DESTRUCTION <br /> INSTALLATION WILL SERVE; {{ RESIDENCE ❑ COMMERCIAL ❑ OTHER_ <br /> N UMBER OF LIVING UNITS: 1 NUMBER W�HEDROOMS; I �1 NUMBER Or EMPLOYEES: 2 <br /> ❑ SEPTIC TANK TYPFJMFC CAPACITY F�ZAV gal 4OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPEIMFO _ CAPACITY got #OFCOMPARTMENTS <br /> ❑ PKG Tx PLANT DISTANCE TO NEAREST: WELL _ _ it FOUNDATION ft PROPERTY LINE ft R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 1Z� LEACH LINES JIS-LEACHING CHAMBERS.__ GCI[.-A�y #OF LINES T _ LENGTH OF LINES�� ft <br /> DISTANCE To NEAREST WE'.L F 75' t FOUNDATION `ft PROPERTY LINE S P }t <br /> ❑ FILTER BED WIDTH ft IZNGTH tt DEPTH ft <br /> DISTANCETO NEAREST WELL_ ft FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENrTH _ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft rOUNDATION` ft PROPERTY LINE. ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH <br /> ft <br /> DISTANCE TO NEAREST WELL H FOUNDATION_ ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST ^WELL. R. FOUNDATION R PROPERTY LINE ft <br /> Q} SEEPAGE PITS WIDTH r-�ri-t1' f�'__"�I ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 100'+ ft POUNDATION 60/ ft PROPERTY LINE St IN <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE 1N ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MINI UM U HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2N)953-7697 yy�� <br /> SIGNED C TITLE� _. DATE V 16 103 <br /> �l <br /> AIV <br /> !I� 7-1416 <br /> O - <br /> / _ — <br /> _ <br /> _ Ub 1C Fk N S yl`ES <br /> b <br /> DEPARTMENT .kCINLY <br /> Application Accepted B Area Employee ID#—V-Y y_ <br /> Final Inspeclion B Date _ 0 SPECIAL PERMIT-Approved by C , <br /> Character of Solt to Depth Df 3 Ft: Pit,'Sulnp Soil Character: <br /> COMMENTS N t31L>�I�bl//7F/�c) �st /S�zn �y hda�P <br /> ,..-I&d ' 6 SST. lcl5�+t��scr�Tia??t�tl s <br /> l�iW7es, �gf�i�q/Ly T T� +3e�/.arc 4tit31 a✓bss.Is: ct� <br /> PE SC Received Amount Permii/ <br /> Code INFO BY- Cash Remitted D to eclueS Invoice# Permit ID# <br /> 42.01-00I <br /> 1212102 ONSITE WASTEWA"fGR PCRMIT <br />