Laserfiche WebLink
ONSITE WAS'I"''NATER TREATMENT SYS PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3 RD FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS d C} CITY�IZfI�P j�LI0L 5-2 L <br /> CROSS STREET APN �`' 1 J —v ` C p <br /> 3� (LjOk Viz_ 3 3� <br /> OWNER NAME U b V I'I I/�"" PHONE �1 Sb2-D <br /> OWNER KESS CITY/STATE/ZIP �� CA -1 S`QLD <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED IALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> 0 FILTER BED WIDTH ft LENGTH ft DEPTH ft O <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ftor.� <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft b <br /> ❑ SEEPAGE PITS NuMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> I 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 /> MimMUN12ylk6UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS T PLEASE CALL(209)953-7697 I� <br /> SIGNED TITLE [/�(lY�/ DATE ! I <br /> - . _— -- <br /> 1 <br /> 4FV <br /> S A UI UN <br /> i <br /> DEPARTMENTSEQNLY t� <br /> Application Accepted By - Date w til 'I S Area Employee lD# ✓� [ �� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft:_ Pit/Sump Soil Character: <br /> COMMENTS C)u-T"_or- ire?tris-E sve�,a7Zc- rr . <br /> L2rl,Oe,,O- � �.�c cT ala-l X14 f2�r--YOAJ P- " tA-n>.9OSA <br /> PE SC Received Check#1 Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />