Laserfiche WebLink
` ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3"FL-STOCKTON CA 95202 -(209)46&3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS <br /> � = � S 11 A LCrtYBIP q c. O <br /> CROSS STREET t 1 i-1 I'T A APN PARCEL SIM ''y � I p <br /> OWNER NAME �Il1M IN 1t_ 51f VAI, NPC ( EJPHONE1T" <br /> OWNERADDRESS t.��My SA,T`sl F l�i�( ,'t,,,�I CITY/STATVZIP K1\ IV1 tfT a `\3LvS� <br /> CONTRACTOR PHONE !RV <br /> CONTRACPOR ADDRESS a:-Z '3•.` I A-1 CITY/STATPJZIP L,)IJ C c S J <br /> LICENSE LI C42 EI C-36 OTHER NUMBER EXPIRATION DATE {. <br /> WATTIFTABLEDEPTI: R GEOGRAPHICAL INFORMATION: CDOrdlnetel X Y Z' <br /> PERCTEST M Z BUILDING PERMIT M LAND USE APPLICATION#P< <br /> TYPEOFWORK: ❑ NEW INSTALLATION ❑ REPAIR'ADDRION ❑ ENGINEER DESIGNED/ALTERNATIVE Y <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER ' <br /> NUMBER OF LIVING UNITS: NUMBEROFBEDROOMS: NUMBER OF EMPLOYEES: <br /> f <br /> ❑ SEPTIC TANK NPFJMFG CAPACITY SAI MOF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY Be] DOFCOMPARTMENTS <br /> 1W ❑ PKC TX PLANT DISPANCETONEAREST: WELL A FOUNDATION R PROPERTY LINE- R <br /> C <br /> ❑ WPf STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(EncLOseD SYSTEM) ti <br /> f <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS NOF LINES LENGTH OF LINES ft <br /> DISPANCETONEARESr WELL It FOUNDATION ft PROPERTY LINE ft -r <br /> ❑ FILTER BED WIDTH IT LENGTH ftDEPTH ft Q <br /> DISGNCETONEAREsT WELL ft FOUNDATION ft PROPERTY LINE R' <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DIWAN"TONEARPST WELL ft FOUNDATION ft PROPERTY LINE. ft <br /> ❑ SUMPS WIDTH R LENGTH a DEPTH ft <br /> DIsrANCETONEARFBT WELL ft FOUNDATION R PROPERTY LINE R n <br /> ❑ DISPOSAL PONDS WIDTH_ft LENGTH ft DEPTH fl <br /> DvYANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCETONEARBET WELL ft FOUNDATION ft PROPERTYLNE ft <br /> 1 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 /> MINIMUM M HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 12091953-7697 <br /> SIGNED - - TITLE(_.... - _1. DATE <br /> '.N <br /> V <br /> f P Efn <br /> M L <br /> EATF DPA <br /> / A - DEPARTMENT USE NLY <br /> APPHestion Accepted By (�Y /�_ J`.1'/ Date T 7< Area Employee IDN <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Suli to Depth of 3 FU Pir/Sump Sell Character: <br /> COMMENTS <br /> PESC R.IVM1 ChecWN Amount Permit/ <br /> Code (NPO —CiaB ReMtend Date ServiccR uestM IRvoiceN Permit IDN <br /> 7�' ­101-/ <br /> 42-0 4)01 ONSITE WASTEWATER PERMIT <br /> 13/MIDI <br />