Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAH JOAQUIN COUNTY ENVIRONMENTAL HFALTH DEPARTMENT 600 E MAIN STREET•STOCKTON CA 85202-(209)46&3420 <br /> i NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 1-5-1/6 CfIT-Y�IZ�IPf `S��F <br /> CROSS STREET �j aJ�� APIN OS3 yil✓ 2-0 _ PARCEL SIZE -147'-w <br /> nn b <br /> OWNER NAME„•,?U,-TC,J-� L <br /> 7 3L),15 6 is L Mt_(.,T- PHONE <br /> /� � n w <br /> OWNER ADnRES$ 1 � 1"1'V P1G 01.1 Ia ��1 Ci7YlSTATFIZP SI- cK 83 <br /> CONTRACTOR Llo-t-PA(L CU,�s�Y2u`c�r-,ra�sln PHONE_dLo - q1- 0, 0O(}) <br /> !j CONTRACTOR ADDRESS .S $ 2 7 .4 A1.�KT rTcT�.�� �CITYISTATEfLF0 - l��''T'7J~) ZJ} <br /> i LICENSE QC42 40-36 OTHER -lJ NUMBER rlil G L Exp,RATION DATE H-ail _ I L� <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y 1� <br /> ❑ PERC TEST 0 BUILDING PERMIT# LAND USE APPLICATION# v <br /> I TYPE OF WORK: G NEW INSTALLATION O REPAIRIADDITION ❑ ENGINEER DESIGNED IALTERNATNE <br /> C REPLACEMENT H OUT-CF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WI LL8ERVE: ❑ RESIDENCE L COMMERCIAL C OTHER <br /> NUMRER OF LIMING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> -)c SEpTiCTANK TYPEYMFG, P 3 L CU^e-,zLr 7G CAPACITY I �-C7 { gal #OFCOMPARTMENTS 2- <br /> 13 <br /> d GREASE TRAP TYFEIMFG CAPACITY gal #OF COMPARTMENTS 1 <br /> DISTANCE TO NEAREST: WELL 5-6 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PLOWP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR{ENCLOSED SYSTEM) <br /> B+ LEACH LINES ❑ LEACHING CHAMBERS a OF LINES 1� LENGTH OF LINES y 0 it <br /> DISTANCE TO NEAREST WELLft FOUNOATION [ ft PROPERTY LINE ft <br /> LI FILTER BED WIDTH a LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST SVLLL It FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it <br /> j DISTANCE TO NEAREST WELL ft FOUNDATION- It PROPERTY LINE ft <br /> - ❑ SUMPS WIDTH fl LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOViDATION ft PROPFRTYLINE R <br /> Q DISPOSAL PONDS WIDTH- ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL RFOUNDATION ft PROPERTY UNIF tt <br /> SEEPAGE PITS NUMBER 3 yIIIDTH �jR DEPTH -,4;—. it <br /> DISTANCE TO NEAREST WELL 100 R FOUNDATION I is PROPERTY LONE , ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL.HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, h <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ` <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> I ' <br /> SIGNED - TITLE ACr--i-r DATE -0//~ // <br /> r <br /> o - <br /> jt'T .All C <br /> r cP A R T M E N N L Y <br /> Application Aecep Date Are Employee ID# <br /> Final Inspection B <br /> Date ! El SPECIAL PERMIT-Approved 6y <br /> Character of Sall to th of 3 Ft: PHISump Sall C erecter: <br /> COMMENTS <br /> PE SC Received Choc Amount Pearluest Y <br /> Date Service Re Invoice 9 Permit ID# <br /> Code INFO a Remitted <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42.01 <br /> 9!21110 <br />