Laserfiche WebLink
/I30 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAH JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(299)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953.7897 FOR INSPECTIONS E%PIRE 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS — O/ CRYZP <br /> CROSS STREET /E/IfFTW� �10 APN 093-NO-Ob <br /> .�t�J4n/ PARCEL$6E � 1— g <br /> OWNER NAME_ /T /=,J 4A <br /> PHONE <br /> OWNER A / � � ctm)q Cm/STATPI[IP � { <br /> CONTRACTOR DILL#N <br /> PHONE No <br /> f — <br /> CONTRACTOR ADDRESS ie0, �oX I�Ee.!/ C17Y/STATE21P L41 `l5 Z34 <br /> LICENSE ❑C42 ❑CJS OTHER NUMBER E)IPIRATON DATE rl <br /> N. WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: CDordinatee % Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION III <br /> TYPE OF WO K: ❑ NEWINSTALLATION ❑ REPAUUAOOITON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBERW13EDROOMS: NUMSEROFEMPLOYEES: <br /> ❑ SEPTIC TANK TYmMFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE'MFG CAPACITY <br /> gal #OF CAMPARTMENTS <br /> DISTANCETONEAAEST: WELL It FOUNDATION R PROPERTY LINE fl <br /> O LIFT 9TATION SIZE TYPE OF PUMP ❑ PKG Tx PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> _ 0 LEACH LINES ❑ LEACHING CHAMBERS #OPLINES LENGTHOFLINES R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R FROPERTYLINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> +. DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WImH R LENGTH It DEPTH - R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O SEEPAGE PITS NUMBER WIDTH R DEPTN R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTYUNE fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M 24 HOUR ADV OUIRED FOR INSPECTIONS-PLEA CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> L <br /> L <br /> C <br /> ` R RU <br /> BOB <br /> 9EPARTMEMiU NLY <br /> ' Application AecePI q Data I� Area Employee ID# <br /> Fina:Inspection Data l'3' ❑ SPECIAL.PERMIT-Approved lty <br /> Character of Soll t0 pth of 3 Ft: PIUSUmp Soil Character: <br /> COMMENTS Bq-1 <br /> r <br /> PE SC Reealved Che Amount Dau PErmIU kmlm0 pannN IDR <br /> CODs INPO G • Remitted SeMca Enuest# <br /> 222 521 s, ITZ-'' d OD <br /> r <br /> L <br /> 42O1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> OR, 1w4/97 <br />