Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 3AN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> —JOB ADDREW C"mP y <br /> :Was STREET APN PARCEL SIZE y <br /> OWNER NAME PHONE <br /> —O'NNFAADDRESS CITY/$TATERIP t <br /> :ONTRACTOR _ PHONE <br /> CONTRACTORADDRES3 <br /> `­JCENSE IJC42 OC-36 OTHER NUMBER EXPIRATIONDATE <br /> NATER TABLE DEFT: it GE WHIWILINFORMAMN: Coordinates X Y <br /> 0 PERCTEST IsBUILDING PERMIT# LAND USE APPUCATION#/:I -!T ' DUB <br /> TYPE OF WORK: ❑`NEW INSTALLATION ❑ REPaWADOITION ❑ ENGINEERDE31GNEo/ALTEWU <br /> ❑ REPLACEMENT ❑ DEBTRUCTNIN <br /> INSTALLATY <br /> ION WI=ERVE: ❑ RESIDENCE 7 COMEW <br /> RL . 0 THER <br /> O <br /> NUMBER OFLMNO UNra: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> —❑ SEPTICTANK TYPEIMFG CAPACRY BBI #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TVPEIMFG CAPACrt 981 #OFCOMPARTMENTS <br /> DISTANCETONEARESC WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SANDOILSEPARATOR(ENCLOSEDSYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFUNES LENGTH OF LINES it <br /> 06TANCETONEAREenr WELL ft FOUNDATION R PROPERTY UNE fl <br /> ❑ FILTER BED Wim ft LENGTH it DEPTH R <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERLY UNE it - <br /> ❑ MOUNDED Wlm R LENGTH it DEPTH it <br /> DISTANCETONEMEST WELL R FWNOATION it PROPERTY UNE R <br /> ❑ SUMPS WIDTH fl LENGTH ft DE tt <br /> _ DISTANCETONEAREST WELL ft FOUNDATION it PROPERTY UNE ft - <br /> ❑ DISPOSAL PONDS WIorN it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY UNE it <br /> ❑ SEEPAGE PRS NUMBER WBTTH ft DE it <br /> DwANCETONEAREST WELL ft FWNOAnON It PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209953.7697 <br /> SIGNED- - `!'_ �— TITLE '-1Tir) DATE <br /> 11 rl9 <br /> E <br /> 41 <br /> % <br /> x <br /> J <br /> RO I C <br /> P <br /> �I /��✓✓// // F DEPARTMENT U g ONLY J' <br /> _Application Accepted B1i_y} �y"Li ._ F'� -,i Dale !'�/r Jl� Ar.. EmplOyae ID# <br /> Final Inspection By Da1B ❑ SPECIAL PERMIT-AppmvedOy <br /> Character of Soil to Depth o73 Ft: PIUSUmp Shc Character. <br /> COMMENTS <br /> PE SC Received LheckiH Amould PONRR' <br /> Cotle INFD B `Cash RemWed Data SeMURogINlst# Invoice If Pazmft 108 <br /> 42.01 ONSfiE WASTEWATER 1RTMM SYSTEM PERMU <br /> 1awT <br />