Laserfiche WebLink
_ ONSITE WAS WATER TREATMENT SYS',,.,OM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH 13EPARTMEW 304E WEBER AVE -3`°Fl,-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Q$ CITY/ZIP :�4-,aa;t <br /> CROSS STREET /_r!GG.c, APN �n72�1/7 �_) PARCEL SIZE Z.• O <br /> /Jm <br /> OWNER NAME nA .Z ([[< / PHONE R <br /> r <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR PHONE3(,64-5-210-7 <br /> r <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE U C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> V WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# r <br /> TYPE OF WORK-.--;N7NEW INSTALLATION ❑ REPADUADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> y, ❑ REPLACEMENT E3 DESTRUCTION (� <br /> INSTALLATION WILL SERVE: O-RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: V <br /> r SEPTIC TANK TYPEIMFG CAPACITY �.yc.�.« gal #OF COMPARTMENTS�# <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELLft FOUNDATION i;, R PROPERTY LME Jt R <br /> r I <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES 9-LEACHING CHAMBERS -,e #OF LINES /V LENGTH OF LINES k3 R <br /> DISTANCE TO NEAREST WELL�. R FOUNDATION SU R PROPERTY LINE '1i R <br /> ❑ FILTER BED WIDTH ft LENGTH R DEFTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LME ft <br /> r <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> r DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME It <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> r SEEPAGE PITS NUMBER y WIDTH 6V It DEPTH -� R <br /> DISTANCE TO NEAREST WELL 'tl/e ft FOUNDATION Sig ft PROPERTY LINE <br /> —c <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 LAWSANDRULESAND REGULATIONS OF SAN JOAQUINCOUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE :,a -1- DATE <br /> r <br /> r <br /> RNTR <br /> TA <br /> r <br /> as <br /> ,a <br /> V <br /> J <br />