Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTN DEPARTMENT WOE MAW STREET-STOCKTON CA 95202-(209)469J34M <br /> NON-REFUNDABLE PERMIT /O CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ae:- <br /> ADDRERS 3D3 S. EID .4ty- CnYZP L/h t>F-lJ A,, <br /> CROSSSTIffET COPPEA-000OL-11 S9 APN 143 -3(Oo -CS vv <br /> SEE fir <br /> AC <br /> OWNERNAME JOSC,"IN �F+P�t/F\CF�p r�/NF.-OZ� �r� PHONEyy✓ -TO J- TT,� e <br /> OWNERADDRESS (8a y- JiF4.-r[- ayx> C-1 • C"mTATEmp SAArrA A2ACA,r-A n40 <br /> CONTRACTOR "VIE 1OA1GEO�uI�'J✓/R-D�VWIEN>"A< PHONE 369- 0T3�5 Q I <br /> CONTRACTOR ADDRESS ,T03FaL T LAI' O,l� CT-- CRYITATELDIP <br /> LICENSE OC42 QC46 OTHER NUMBER E"IMTION DATE <br /> WATER TABLE DEPTH: it GEOORAPHICALINPORMATIOH: COordlnates % V <br /> PERCTEST # BUILDING PERMIT# LAND USE APPLICATION# R-I Oy <br /> TYPE OF WORK: O NEW INSTALLATION O REPNNADORION ❑ ENGINEER DESIONED/ALTERNATIVE <br /> ❑ REPLACEMENT D DEaT111C1gN <br /> INSTALLATION WILL SERVE: O RESIDENCE ❑ Commemicu. ❑ OTHER <br /> HUMMER OF LING UNITS: NUMBEROFBEDROOMS: NUMBEROFEMmO : <br /> ❑ SEPTIC TANK TYPHMFG CAPACITY gal #OFCOMPARTMENrS <br /> ❑ GREASETRAP TYPEJMFO CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCETONEAREST: WELL ft FOUNDATION If PROPERTY LINE it <br /> ❑ LIFTSTATION SUE TYPE OF PUMP O PKGT PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHINGCHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WETN ft LENDTH R DEPTH ft <br /> DISTANCETONEAREST WELL R FWNOAhcH It PROPERTY LINE ft <br /> ❑ MOUNDED MOTH It LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE it <br /> ❑ SUMPS WIDTH it LEM3LN ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTYLINE If <br /> ❑ DISPOSAL PONDS W1DTx ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WOTR it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMIJM§C HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED Ire TITLE GshtSL6-.TN/R/r DATE 7 <br /> TIF11111 111111 1111111 <br /> en aw' -ry <br /> 3IaaM ' •dye <br /> LLf o p a <br /> Mor za <br /> a wRa#AlOOE W� N U F. <br /> W z a <br /> Ag046 1 � GK �0Q <br /> awAam lie p D® av Ta IP 'I 5/L�L.J� a O Y <br /> to ALL Say ' z r' <br /> u <br /> bIVC 1iVKALXTQtBM'AR MRa LAI! <br /> DEPARTMENT USE ONLY <br /> AppllCation ACcepte#By Date�J��S- h Area 0 C Employee IDS <br /> Final Inspection By net. ❑ SPECIAL PERMIT-App...by <br /> Character of Soil to Depth of 3 FU Pi#SMmpSoil Character. <br /> COMMENTS <br /> PE SC REosiv.ti he Amount Permit/ <br /> Cobs two By <br /> Cseh Remlfte# Ds1e Service R. Meat# Imolu# ParmK lDp <br /> 222 13b 10iz' 3$-1 cj � <br /> 42-01 ONSITE WASTEWATER TRTAWT SYSTEM PERMIT <br /> 1Of4U7 <br />