Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE .340 FL-STOCKTON CA 95202 - (209)46 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR:INSPECTiONS <br /> EXPIRES I YEAR FROM DATE ISS <br /> -7 L-7q <br /> JOB ADDRESS CITYIZIP eq <br /> n <br /> CROSS STREET LIve V APN_Q� - o qo - 3 q PAR <br /> _ �e. 1 <br /> J{'�� CEL SIZE <br /> rQ <br /> OWNER NAME 1 Vh PHONE <br /> OWNER ADDRESS �1 + _ 4 4y� P <br /> -� CITYISTATEIZI -s R"��' �• <br /> CONTRACTOR <br /> � PHONE <br /> CONTRACTOR ADDRESS CITYISTATEIZIP ` <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAER/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑_ RESIDENCE © COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG' CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> 0 PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION tl PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> -. KLEACH LINES ❑ LEACHING CHAMBERS #OF LINES / LENGTH OF LINES / tj <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE t� <br /> ' ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ti (¢ <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> �EEPAGE PITS WIDTH 1-3 ft LENGTH ft DEPTH �f J tZ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 ORDINANCES, <br /> STAT�AWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI 24H ARVANCE NOTICE REQUIRED FOR INSPPpECTIQNS-PLEASE CALL(209)953-7697 ! <br /> SIGNED / "6�Ir TITLE �°r"!L?�h DATA <br /> ,, <br />