Laserfiche WebLink
—"—'' <br /> � www r V ww �r_FN 1 r\GP11 IVIGIY 1 0 10 1 CIVI rCl[IVII 1 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS A ,E-X.PIRESpr1�JVYEAR FROM DATE ISSUED <br /> Z <br /> JOB ADDRESS O— — GD <br /> . - 0XHrrNe'1 FER44► CITYIZIP T 1�}•U.1 l J4 <br /> CROSS STREET_u I-i Tl l�l'�y qpN_ ZS s� I v 0-+ PARCEL SIZE o�r. <br /> OWNER NAME KAcoSE2 9-i1vIVC.A �.-L-� PHONE (vIO <br /> • OWNERADDRESS 1P.0. 150)( / 5- ,p, CITY/STATE/ZIP O�►JlD,4 CA '745te3 <br /> CONTRACTOR W V E C)&IL, G�•I5QyE.MV I(Z'iJ MEkr r`IV PHONE 3(el"o1w may` y� <br /> CONTRACTOR ADDRESS IfO� vi. OAW— ST. CITY/STATE21P_LOD I CA /i 2-�y <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST # -1 BUILDING PERMIT# LAND USE APPLICATION# 1 - I - <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH_ ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft 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 ORDINANCES, <br /> %441 HOSTATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMlJh,./\ UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 �+ <br /> SIGNED 'S TITLE DATE s <br /> ....... ;yi ....,y.. OWNERS <br /> 'Nr,v�f•m1Y1 I.R=p611- <br /> •DE4GNAo D�OWNDOI• I � oiw�u.•... CIS4 1 <br /> ��.. •p °'Y'L� V <br /> _ hi z� <br /> C-) <br /> a•. '� I r'8.-. NOTES �� t1/ <br /> c.. <br /> CL <br /> craw <br /> aba'v.' t�s•,9 •'Y <br /> PARCEL4• <br /> _ "P,ucawoe•.s � is wic w.n � - P��DCL-�•bb.L <br /> .e.o SITE C PµRCELs- ` <br /> DURF(AM__ FERRY RO-AD-xo-.+ <br /> VICINRY AIAP °�`"�''° LiX°'v <br /> � /n/+�/ DEPAR- US ONLY <br /> Application Accepted By "✓ Date Area V ( � Employee ID# !V <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft:_ Pit/Sump$pig Character. <br /> COMMENTS Fof M S FIR �� 00 �-2-19_ <br /> ,f��S <br /> PE SC Received - Amount PermiU <br /> Code INFO B Cash Remitted Date Service Re uest# Invoice# Permit ID# <br /> -z Sa3 lSs l <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />