Laserfiche WebLink
12V01 00� ZZ ��•j <br /> ONSITE WASE WATER TREATMENT SYSTi PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH Dl,rARTMENT 304 E WEBER A,.-: 3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> 9 ly <br /> NON-REPUNDABL PERMIT i! CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> J08ADDRESS �P. JMMA - CITY/ZIP. <br /> �• i <br /> CROSS STREET O APN 7c: -260-- 13 PARCEL SIZE ' <br /> II 1 ad <br /> OWNER NAME � PRONE � ` (�,3 <br /> i OWNER ADDRESS I orf �! I Y�1 OCITYISTATEIZIOSOCUTC r `7 <br /> r CONTRACTOR . h 54 PHONE X607 <br /> CONTRACTOR ADDRESS 'I CITYISTATE/ZIP jLAft:-A L-11-1i <br /> 1Y <br /> ! LICENSE C-42 ❑C-36 11 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> i ❑ PERC TEST 1) 11 BUILDING PERMIT# LAND USE APPLICATION# <br /> ti! TYPE OF WORK: . NEW INSTALLATI 1`/ L3 EPAIR/ADDITIO ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> E REPLACEMENT ICr 1 DESTRUCTION <br /> I INSTALLATION WILL SERVE: SII RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: `I NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG �p CAPACITY l 0 g31 #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> Ip Saf <br /> 0 PKC TX PLANT DiSTANCET`O ON WELL 4- ft FOUNDATION ft PROPERTY LINE,-_- go � $ <br /> ❑ LIFT STATION SIZE i TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY CINE <br /> .V <br /> ❑ FILTER BED WIDTH 1i ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH II ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ' ❑ SUMPS WIDTH '� ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> l DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 /> Mi M 4� N E NOTICE REQUIRED FOR IN E TI NS-PLEASE CALL(209)953-7697 <br /> SIGNED ` TITLE DATE J~ <br /> I <br /> ! <br /> 11C L <br /> I � <br /> � 1 a <br /> M <br /> p <br /> r <br /> i� <br /> SAh J DAUI 0C N <br /> Ik EN <br /> i, <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date OS Area Employee ID# ��ACL( e7 <br /> Final Inspection By. Date ❑ SPECIAL PERMIT-Approved 6y <br /> Character of Soil to ep of 3 Ft: iM Pit/Sump SoilCharacter: <br /> COMMENTS ` <br /> .p <br /> i <br /> cod <br /> NF Received Check#! Amount DateIrit) Permit/ Invoice# Permit ID# <br /> Code INFO B ¢ Cash Remitted Service Request# <br /> y2.ry �►sS- ! ,-o J <br /> i 42.02-001 I` <br /> ' 121I2R001 ,i <br /> ONSITE WASTEWATER PERMIT <br />