Laserfiche WebLink
i <br /> ONSITI ASTEWATER TREATMENT SYSTE�'ERMIT <br /> SAN JOAQUIN COUNTY ENVIRUNMENTA—e.ALTH DEPARTM ENT 304 E WEBER AVE-':,- FL-STOCKTON CA 95202 -(ZO9)46&342D <br /> NON-REFUNDABLE PERMIT CALL 2"1953-7697 FOR INSPECTIONS EXPIRES I YEAR D S n f) <br /> JOB ADDRESS 4 CrrviZIP26gC <br /> i APN I �5 dCROSSSTREEF PARCELSI' • <br /> OWNERNAME PHONE1Gt CITUISTATVZ —V /Al¢WNER ADDRESS v� <br /> `y <br /> CONTRA CFOR <br /> PHONE <br /> CONTRALTDR ADDRESS CITYISTATEIZIP run <br /> r• � <br /> LICENSEfl C-42C-36 CYPHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: A GEDORAPHICALINFORMATION: Coordinates X Y <br /> M ❑ PERC TEST # BUILDING PERMIT# b&SeALAND USE APPLICATION# <br /> c TYPE OF WORK: A NEWINSTALLATION ❑ REPAIRIADDITION ❑ Ey01NEERDESIGVEDIALTEKNATIVE <br /> � ❑ REPLACE:MF.NT ❑ DESTRur--riON <br /> INSTALLATION WILL SERVE: 0 RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NI;MBER OF BEDROOMS; 1 NUMBER OF EMPLOYEES: ` <br /> SEPTICTANK TYPUMFG CAPA TY L gal #OFCOMPnRTMF:NiS <br /> ❑ GREASE TRAP TYPEIMFG CAP CITY gal #OFCOMPARTM15"S <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WEL4 ft FOUNDATION ft PROPERTY LINE - ft <br /> ❑ LIFT STATION SizE TYrE OF PuMr S ND OI SEPARATOR(ENCLOSRD$VSTT ) <br /> LEACH LINES ❑ LEACHING CHAMBERS /#of Ll Es LENGTH OF L16E5 ft <br /> DISTANCE TO NEARE51' WELL tt FYIONOATION ft PROPERTY LIKE ft <br /> ❑ FILTER BED WIDTH tt LENGTH R Dm iH ft <br /> DISTANCETONEARESr WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISIANt]CTO NEAREST WEI.1. ft FOUNDATION R PROPERTY LINE fl <br /> O SUMP$ WinTx ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL. fl FOUNDATION _ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS Wllrrx ft LENGTH ft DEPTH ft <br /> DISEANCETONEAREST WELL R FOUNDATION A PROPERTY LINE O <br /> ❑ SEEPAGE PITS NUMBER WIMII ft DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY j <br /> D INAN'CE STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IN UM <br /> 0yjDVANCE NOTWE REQUIRED FOR IN^ - 1ON. PLEA F.CALI,(209)953-7697 <br /> SIGNED '1'E9'LE DATE Q <br /> i i <br /> SLSPPLY FZ201"1 �t1 I � �. ! r � v <br /> �,JUIZC�, <br /> -- / -Nil <br /> `1 FNU 1 1H O <br /> F_ T C <br /> DEPARTMENT USE NLY <br /> Application Accepted By Date Area Employee IDtt <br /> Final Inspection By Date v Q SPECIAL PERMIT-Approved by r <br /> Character of Soil to p Df 3 t: P Sump Soil haracr<r. <br /> COMMENTS <br /> PE SC Received ec Amount Date Permit! Invoice# Permit ID# <br /> Cade INFO BY Cash kemiHed Service Re uesl# <br /> zlb 15c7 a c}— Y a 3 z 8 S <br /> 42-02-OD] ONSITE WASTEWATER PERMIT <br /> f 2!2212003 <br /> 1 <br />