Laserfiche WebLink
ONSITE WA�`,,,WATER TREATMENT SYSI 4 PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER Atis Ems•3°O FL-STOCKTON CA 95202 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT <br /> /- CALLC 209 953-X76(9,7 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �//76� � /-0{✓L� S�:�A'YyJt.A�/lJ Oegf CITY/ZIP�Tja ok'n Al' �(J LA <br /> CROSS STREET L'Lsj`-(�T //7/1-L APN DQ - GSo- o`-f PARCEL SIZE I �y4 C a <br /> OWNER NAME yO��}LO.(l Z"4 snezz Z'al--4tl/-Sff�P PHONE -? <br /> OWNERADDRESS �0/OZ. /✓ 1-,C&,1 ,Q +� �'�i�If CITY/STATE/ZIP <br /> J <br /> CONTRACTOR 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 /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# L.[J.4-CO-2 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ 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 TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 1 <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft L <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft rl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R C <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R rn <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> I 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. ^l} <br /> INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEA/ISE CALL(209)953-7697 <br /> SIGNED TITLE ��CSL�/T �� DATE <br /> CONSTRUCT C SEWER DISCHARGE ----- <br /> FRON CARETAKER BUILDING TO <br /> EXISTING SEPTIC TANK <br /> IV 9' HIGH WATER <br /> +NK O 15,000 GIl. q� ' <br /> %PACnY M74 RMT <br /> FOUNDATION <br /> OTHERS) N <br /> SEPTIO TANK 1a.ak r _ _ _ _ _ _ _ _ _ _ <br /> LL _-- - - <br /> - 7 - <br /> EKSTMO S�PT�c TA� L_ — — — _ <br /> AND LFIDH FIELD II - - L <br /> 3'-6.14'-6 WATER F - <br /> THIS LODATION <br /> DEPARTMENT UE yi ON)L.Y `f <br /> Application Accepted By >f—/��c Date j 10,5- Area Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS OLeT OF- S IES/Its S7iG SJS7�M >°EQ+t tT. kE cSb Or- 7�tr i S kpTcc SyST6Pt <br /> LS SLtAtJ`E<-7- 7-D 5FfoO AQ£uSE SOL rG `/ £1-r I) �:7:7,vSyE C-770N P CF_Gd [t 9-.E-4 . 4,00/T70-w41- <br /> 1- .4c - 1-4 a- E r A2£27 . S S E1- 17- # - <br /> PE SC Received Check#/ Amount Date ermitl Invoice# Permit ID# <br /> Code INPO B Cash Remitted nServicPe Re uest# <br /> 42..(oq '{� -Gl-' /C S o, <br /> 42.02.001 ONSITE WASTEWATER PERMIT <br /> 1222/3003 <br />