Laserfiche WebLink
ONSITE WASTEWATER�EATMENT SYSTEM PERMIT <br /> JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3X"PL-STOCKTON CA 95202 *4468-3420 <br /> NON-REFUNDABLE PERMIT CALL 1 (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jan ADORESS - 2" E. _-1c^ %tA.Y )�.. CITY/ZIP ,, q •.a\ L�., ( n-, n <br /> L)$$STREET' APN ( PARCEL SILE V" <br /> Owrv[a NAME f' 1 -. - '✓\ PHorve <br /> NER ADDRESS 1 y� .�> CITY/STATE/&P r� I a\` /). t ("� I <br /> MCTOa t1`_ll r1 r . PHONE <br /> L <br /> CONTRACTORADDIOSR '1 L .I S I I ..E t jf' CITY/STATEJZIP <br /> ENSE <br /> LI C42 CI -36 OTHER NUMBER E%PIMTION DATE <br /> TERTABLEDEFOU ft GEOGRAPHICALINFORMATION: Coordinates X Y, <br /> Cr PERC TEST(S) NUMBER LAND USE APPLICATION# ' . <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIN/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPWCEMENT ❑ DESTRUCTION <br /> r ITALLATIONWILLSERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> �rrl NUMBE0.0F LIVING ENDS: NUMBER OF BEDROOMS: NUMBEROFEMPLOVEES: <br /> L <br /> SEICTANK TYPEJMFG CAPACITY gal #OF COMPARTMENTS <br /> PT <br /> GREASE TRAP TYPNMFG CAPACITY gal #OF COMPARTMENTS <br /> PKG TX PLANT DISTANCEWRICARESf: WELL ft FOUNDATION ft PROPERTY LINE R <br /> I❑ LIFT STATION Sim TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OFLINES LENOTH OFLINES It <br /> Y DISTANCETONEAREST WELL ft FOUNDATION It PROPERTY LINE R <br /> ❑ FILTER RED WIDTH A LENGTH R DEPTH ft <br /> DISTANCETONEAREET WELL R FOUNDATION ft PROPERTY LINE R r <br /> MOUNDED WIDTH R LENGTH ft DEPTH it N <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE fl N <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> N DISTANCE TO NEAREST WELL ft FOUNDATWN ft PROPERTY LINE fl <br /> 71 <br /> LN DISPOSAL PONDS WIDTH R LENGTH R DEPTH B <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE It Lf <br /> ❑ SEEPAGE PITS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> 3 <br /> LUDY 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. J <br /> MI M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPFCI'10'S-PLEASECALI.12041953-7"7 <br /> vNE TITLE G ?�^1 DATE <br /> ,4 otJ )t)51> .oe17, S£12 ,X£t. , Ififi <br /> o <br /> IS%Z N IO2Z .OA1 O_S-ZAYMI <br /> N a N 4 r ECEI <br /> t{tJItlb�fi� ,ofifi ' F�� x'420 <br /> N NTAL <br /> FNgyEPAHTWI. <br /> - ;✓i DEPARTMEJN'Jr4 ON Y <br /> �H.LII.LAtcepted By /7� Date '] j4 Area Employee ID# 99 <br /> al Inspection By Date ❑ SPECIAL PERMIT-Approved¢y <br /> ratter of Soil to Depth of 3 Ft: PIGSamp Soil Charaeler: <br /> ` <br /> COMMENTS <br /> E SC RoOdVed Amaunl alp PeOUR] IHyai.It Permit IM <br /> Code Ines B C.O. Remitted Service Ra vest# <br /> 6f7 .sz sz s e w-w )' 1�12.CJo 5L1 W, <br /> I-0DI ONSITE WASTEWATER PERMIT <br /> 122D2 <br />