Laserfiche WebLink
10/05/2004 15:25 4640138 ENVIRONMENTAL HEALTH PAGE 03 <br /> ONSITE WASTEWATEI,,�ZEATMENT SYSTEM PERMIT <br /> tN J_OAQIJtN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE•3""FL-STOCKTON CA 95202"W(209)4683420 <br /> PN-REFUNDAB E PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED n <br /> vDDaE9S LAI C\�r � `;4 <br /> APN PARCEL SIZE <br /> S STREET <br /> PHONE <br /> IWNER NAME <br /> CITU/STATE/ZIP <br /> 1 IER ADDRESS <br /> ` PHONE <br /> : IFA^.CTOR <br /> CITV/STATE/71P <br /> ;ONTRACTOR ADDRESS <br /> :NSE ❑C-42 ❑C-36 OTHER <br /> NUMam EXPIRATION DATE. <br /> fl GEOGRAPHICAL INFORMATION': Coordinates X Y <br /> i rERTABLEDEPTH: <br /> Pr RC TEST(S) NUMBER LAND USF.APPLICATION p <br /> :3REPAIR/ADDiTION ❑ ENGINERR DESICNED/ALTERNATIVE <br /> ( �E OF WORK: :3 NEW INSTALLATION ZI DES•TRUCI'ION <br /> ❑ REPLACEMENT <br /> Q ❑ OTHER <br /> I+sTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL NUMREROFEMPLOYEGS: <br /> NUMBER OF LIVING UNITS: NUMBER Or BEDROOMS: <br /> � SEPTIC TANK TYPE/MPO <br /> CAPACITY gut 9 OF COMPARTMP.NTS <br /> GREASE TRAP TVPF/MFG <br /> CAPACITY_— gal #Of COMPARTMENTS <br /> ❑ PKG TX PLAN DISTANCE 7'O NEAREST: WELL <br /> It FOUNDATION it PROPERTY LINE ft <br /> LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SV9TF.M) <br /> fl <br /> LEACH LINES O LEACHING CHAMBERS #OF LINOS LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE <br /> Ft LENGn1 _ R DEPTH ft <br /> rl FILTER RED WIDTH ft <br /> DLSTANCFTONEAREST WELL t: FOUNDATION fl PROPERTY LINE <br /> MOUNDED WmTH _11 LENGTH ft DEPTH ft <br /> R <br /> fl FOUNDATION R PROPL•ft'V LINE <br /> DISTANCE: ST TO NEAREWELL fl <br /> WIDTH R LENGTH fl DEPTH <br /> ❑ SUMPS fl <br /> D[cTANCE TO NEAREST WELL ft <br /> FOUNDATION f< PROPERTY LINE <br /> ft DEPTH fl <br /> DISPOSAL PONDS WIDTH_ ft LENGTH — ft <br /> _ft FOIINDA'rION R PROPERI'V LINE <br /> DISTANCE,To NEARESTWP.LL IT <br /> ft LENGTH A DEPTH <br /> ❑ SEEPAGE PITS WIDTH ft PROPERTY LINE <br /> ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION <br /> _Hr.REBV CERTIFY THAT I HAVE PREPARED THIS <br /> LAWS AND S ON ANDES H REGULATION BOF SAN.IOAO E DONE IN CO COUNTY.WITH SANRDANCE JOAQUIN COUNTY ORDINANCES. <br /> MINIMUM 24 HOUR ADVANCE.NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(-tW)953-7697 <br /> TITLE DATE <br /> 1 GNED <br /> DEPARTMENT USE ONLY Bmployce IDN/ <br /> Datc Aro1�_- <br /> Applieatlon Accepted By ❑ SPECIAL PERMIT•Approvcd by <br /> Final Inspection By Date Plt/Sump Soil Character: <br /> Character of Soil to Depth of 3 Ft: <br /> COMMENTS <br /> Permit/ Invoice# Permit ID# <br /> PE SC Reccived Ch Uit#/ Amount Datc Service Re uc5t# <br /> Code <br /> INFO By Cash Rcmltted ,� <br /> ONSITE WASTEWATER PERMIT <br /> 42-01-001 <br /> I711in2 In/n5/9nn4 TTTF.. 14:57 ITX/RX NO 76101 2004 <br />