Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 952D2-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �• - 4 - CrTYMP K` <br /> CROSS STREET APN /OS.-DY:O-10-S, PARCEL S¢E -`-I 0 <br /> �G.00 - <br /> OWNER NAME � PHONE <br /> OWNERADDRESS CITYISTATE/LP <br /> j'^v_,1 (�1'�fi_ fL� <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS H t , � ..I.0,-Y— —CITY/STATEMP <br /> LICENSE QC42 QC-36 OTHER NUMBER&ft fkSIRATIONDATE 61- <br /> WATER TABLE DEPTH: R GEOGRAPHICALINFORMATION: COOrdinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# .i LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER <br /> REPLACEMENT � . r DESTRUCTION O L-0 "K— <br /> INSTALLATION WILL SERVE: -rrSIDENCE ❑ COMMERCIAL 13 OTHER <br /> LIVING OF LNG UNITS: v NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> q/S'EPTIC TANK TYPE/MFG Pd::L CAPACITY gal #OF.COMPARTMENTS _ <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY_ gal #OF COMPARTMENTS <br /> LL <br /> DISTANCE TO NEAREST: WE �t'J1 �}..-���/ R FOUNDATION, n PROPER7YLINE 3,d R <br /> P <br /> ❑ LIFTSTATION SIZE TYPE OF UMP 0 PKGTXPLANT 13 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> EACH LINES ❑ LEACHING CHAMBERS #OF LINES ,_ LENGTH OF LINES q1S R <br /> DISTANCE TO NEAREST WELL L'715 R FOUNDA710N��R PROPERTY LINE�a) R O <br /> ❑ FILTERBED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE To NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH R <br /> _ DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY❑NE R <br /> O SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL 0 FOUNDATION It PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELLR FOUNDATION_ R PROPERTYLINE 0 <br /> pISEEPAGE PITS NUMBER WIDTH It it DEPTH r R <br /> DISTANCE TO NEAREST WELL It FOUNDATION --- R PROPERTY LINE Ir11 R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION 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 /> MINI UM HOUR i6DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TITLE DATE <br /> PAYMENT <br /> RECEIVED <br /> MAR 01 2012 <br /> I <br /> - - / SAN JOAQUIN COUNTY <br /> _ EHVIRONMEWrAL <br /> HEALTH DEPARTlIENT <br /> Itj <br /> Otj <br /> DEPARTME TU LY <br /> Application on Acc a D 3 ( Area Employee ID# <br /> Final Inspection Date �Z ❑ SPECIAL PERMIT-Approved by <br /> Character of So R to th o13 Ft: PIUSump Soli Character: <br /> COMMENTS 014 O F Go Q D w S S&-7;& 4.sp S <br /> Cry -- <br /> CG7�IW <br /> PE SC Received ChecW Amount Permit/ <br /> Code INFO By Cash Remitted Vaq Service Request# Invoice# PermltlD# <br /> 4-2-10 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014107 <br />