Laserfiche WebLink
I ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL <br /> HEALTH DEPARTMENT 304 E WEBER AVE-3`°FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT ljv// 42T5CALL(209)953-7697 FOR INSPECTIONS EX,/PIRES 1 EAR FROM DATE ISSUED <br /> JOBADDRESS S CM/ZIP /(, <br /> 2�5��5'v 3 <br /> CROSS STREET PARCEL 512E � <br /> C <br /> OWNER NAME �7 PHONE 3 6o U <br /> ( <br /> OWNER ADDRESS mac/ / <br /> U S /""7 w Y 7� CITY/STATE/ZIP Cv <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> bass LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# 2 <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAHUADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE JX COMMERCIAL ❑ OTHER �'7 <br /> NUMBER OF LIVING UNITS: 7 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFGCAPACITY f Z'O Sal #OF COMPARTMENTS 2� <br /> r ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL _5-D ft FOUNDATION_ R PROPERTY LINE /O O R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ss. <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R I <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH ft <br /> _ DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ SUMPS WIDTH R LENGTH n ft DEPTH / ft <br /> DISTANCE TO N AREST WELL G2�—it FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCETO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NumaERWIDTH ft <br /> RE DEPTH ft <br /> DISTANCE TO NE WELL R FOUNDATION ft PROPERTY LME ft <br /> aaa� <br /> 1 HEREBY CERTIFY THAT I H EPA D THIS APICA ON AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUh HO DVA O C UI ED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> saw SIGNED TITLE42/� DATE 1-V/, <br /> t <br /> r� <br /> A <br /> DEPARTMENT USEONLY <br /> Application Accepted By Date d Area Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De of 3 Ft_ Pi Sump Soil Character: <br /> COMMENTS T <br /> 2 <br /> PE SC Received Ch ec Amount Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted <br /> ate Service Request# <br /> 2� 1?eo 3 'G-13 <br /> aa. .QjG(.✓! CJ 0q 'T ITE WASTEWATER PERMIT <br /> 1 -02-001 <br /> 12222003 4 <br />