Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> FSAN JOAQUIN COUNTY ENVIRONMCNTAL HEALTH DEPART,116T 304 E 1VE BER AI'E-3X°Fl.-STOCKTON CA 95202 - (209)468-3420 <br /> N ON-REFU N DABLE PE�RMIT! CALL(209)953-7697 FOR INSPECTION'S EXPIRES I YEAR FROM DATE.ISSUED <br /> JOB ADDRESS I J� �l/F7 �r,7 � CITI'IZIP <br /> .nti� �,, �.a <br /> 'CROSS STREET �F Y�r _ 'I APN i PARCELSIZE <br /> OWNERNANIE G��G-fs'/.�- I� [�- �1'VL L_l.�l�� PHONE TIl•`/�� �{' •`��' <br /> OWNER ADDRESS Z!��3 �5„� l,l <br /> �CnsYSrATEIZIr <br /> CONTRACTORL�PHONE (� /1C,.�1f7��f[�.' A <br /> CONTRACTOR ADDRESS 1 1 1 {�Q II�V u� � ��r -7---,�CIITYYIIS�T7A(TTEIZIP :._7 �b4J N ,CK�/-L-32-V.5 <br /> LICENSE 21�,-42 ❑C-36 OTHER �I NUMBER 1 J 1 S{ZJ EXPIRATION DATE V Cf I <br /> WATER TABLE DEPTH: ❑ GFOGRAPFIICAI.INTOR,M1IATION: Coordlnales X Y Sy <br /> I❑ FERC TEST(S) NUMBER _.� __ LAND USE APPLICATION# -_ <br /> TYPE OF WORK: ❑ NEWINSTALLATION REPAIRIADDITION ❑ ENGINPFRDF.SIGNEDIAL•I'ERNATIVE <br /> ❑ REPLACEMENT �I ❑ DESTRUCTION <br /> I <br /> INSTALLATION WILL SERVE: RFSIDENCE ❑ COMMERCIAL ❑ OTHER <br /> a NGMBER OF LIVING UNITS: �j, y�I NUMBER OF BEDROOMS: r7� NUMBER OF EMPLOYEES: <br /> lA4 SEPTICTANK TYPFIMFG 1.1'11`�'GFC.&'11E' •!' 1`—i L- CAPACITY L+00 gal #OFCOMPARTMENTS G- <br /> ❑ GREASE TRAP TYPE/MFG it CAPACITY gal #OF COMPARTMENTS O <br /> F r � I <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL �I J�'�- fl FOUNDA"I"ION ft PROPERTY LINE ft <br /> ,❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ,f 1 1 <br /> ❑ LEACH LINES $ LEACHING CHAMBERS :I -" "e-`t#of LINES ! LFNGTH OF DNFS __9D R <br /> r 5 f n <br /> FF DISTANCE 70 NEAREST WELL R FOUNDATION PROPERTY LINE <br /> ❑ FILTER BED WIDTH tl I�LENGTH A DEPTH tl <br /> DISTANCE,TO NEAREST WELLI fl FOUNDATION fl PROPERTY LINE ft pi <br /> ❑ MOUNDED WIDTH R :LENGTH A DEPTH fl { <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft 11 <br /> ❑ SUMPS WIDTH ft !'LENGTH D DEPTH ft <br /> DISTANCETO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL,PONDS WmTft <br /> H :LENGTH D DEPTH <br /> F DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE R <br /> 3 SEEPAGE PITS WIDTH �FO 1f R I�TH 3 11— DEPTH fl <br /> DISTANCE TO NEAREST WELL )�(�I t' R FOUNDATION 2 PROPERTY LINE S l fl <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, � <br /> STATE LAWSAND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M1IINIMUM 24 HOUR ADVANCE 1NOTICE REQUIRED FOR INSP <br /> E <br /> CTIONS-PLEASE CALLL(2p04)953-7647 <br /> SIGNED <br /> - it TITLE `..�J � y sf-� DATE (.� '✓ <br /> L <br /> II <br /> Q 1 <br /> I <br /> Au <br /> ,I o <br /> P <br /> (I C a <br /> I� a . <br /> I� IN q N <br /> Nut <br /> IJFA-Tfi DE <br /> i17 <br /> 'I <br /> 31 <br /> DEPARTMENT USE O-'LY f <br /> Application Accepted B 'I Date Area�1Employee 1D4 <br /> FFinal Inspection '. Date Y ❑ SPECIAL PERM 11'-approved by <br /> Character of Soil to D th of 3 Ft: 11 PillSump Suit Character: <br /> COMMENTS /Y��s i G l� Y� <br /> PF. SC Received Checked' Amount Permit! <br /> 1 I D to Invuice# Permit IDN <br /> Corte INFOIly �Cash 1 Remitted Service Re uest# <br /> t a <br /> 4.°-01-001 <br /> 1212102 ONSITE W'ASTEW'ATER PERMIT <br /> i!� <br />