Laserfiche WebLink
ONSITE WAS :WATER TREATMENT SYS' 'M PatNED <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH "6ARTMENT 304 E WEBER-3RO 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 S t d CTTY/ZIP <br /> y <br /> 91G <br /> m <br /> CROSS STREET (l�G In- 0%^ 1-I&M1--71— APN ? �� Og0'� PARCEL SIZE I'S.�/ o <br /> v <br /> OWNER NAME PHONE <br /> N <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR tA O PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 36 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAHUADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL A FOUNDATION ft PROPERTY LME R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ FILTER BED WIDfx ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE R <br /> QL. MOUNDED WIDTH ft LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE it 11 <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WBYTx ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> 1 HEREBY CERTIFY THAT I 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED 4�TITLE DATE 1 - -21-0 <br /> P <br /> O <br /> 4Aft <br /> 0" M N AL P <br /> " -DEY]CRTA. <br /> A dl11ication Accepted B Date Area Employee ID# 9J <br /> F npl Inspection By Date [3❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth.1`3 Ft: Pit/Sump Soil Character: <br /> COMMATS 1/f 1.1ILL�s✓fP� �-Itis / Pool�f/1 / 9GSl6r�» ee%✓1�^� --nez�e <br /> Gt�a3���et+f�uco�-.f-i Na;��7• i�'i�r3�es�^fi� l�.(�J <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code I INFO B as Remitted Service Request# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />