SU0005756 - Laserfiche WebLink

Home Browse Search

--Ol�SIT.EV6';AST"WATER TREATIVIEN -SYYST�'M PERMIT �. I SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH fRTMENT ,,�'30¢Yf WE$ER -3""FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1-YEAR FROM DATE ISSUED JOB ADDRESS 1 6 + [�' CITYIZIP J� C I CROSS STREET r APN � 7-2 Z3 2±x$ PARCEL SIZE l 1 C p OWNER NAME L ONE i +` r OWNER ADDRESS $ IAI1' '+1i1, 2 CITYISTATEIZIP 5 x4 2- CONTRACTOR ! f 1 J�oc PHONE" a CONTRACTOR ADDRESS OZ I �^ CITY/STATE/ZIP Lod,• !�L`� LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y _14 '� PERC TEST(S) NUMBER, LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ 'REPAIR/ADDITION ❑ E GI iGN / RN IVF ❑ 'REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER. NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: N ❑ SEPTIC TANK TYPE/MFG CAPACITY gal 1#OF COMPARTMENTS - ❑ GREASE TRAP TYPE/MFG CAPACITY gal ;q#OFCOMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ .LIFt1STATIPN SIZE TYPE OF PUMP! ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft f DISTANCE TO NEAREST WELL ft FOUNDATION ft P.ROPERTYLINE ft ❑ FILTER BED WIDTH ft LENGTH r ft DEPTH '. ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ,. ft, ES4i ❑ MOUNDED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE. e:p�.. �'��.=.ft E - ❑- SUMPS WIDTH ft LENGTH ft DEPTH'' - %ft -` DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH • ft DESTANCE TO NEAREST WELL ft FOUNDATION tt PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH- ft LENGTH ft DEPTH, DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. r. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)953-7697 i SIGNED �7 TITLE DATE [i i v I I ' TAb y r P t Ca F -vo 751 Lit h, e ri r { } T)Wn 1E LL L- f A' ti E r� fE DEPARTMENT SE�NLY" F� �p f �Agppi-kation Accept�d y Date U Area �`—y ! Employee lD# 01, 9 ! C. Final I>9gec&..B` Date�� d% ❑ SPECIAL PERMIT-Approved by Character of Soil epth of Ft: " Pit/Sump Soil Character: �j COMMENTS L 9[ Zcti.t C� C'� •.t ram `�1 ��C�r.._res�rte.��_ri` c� /._._ ' �0,� 1�✓it :CT :r��]t✓C'�_cY�ir�s�ri r'-��y�.rr._�. +��...Q�iz�-.� -.�C�.9�ct,<.c .r�-.z_�..:_.�K s� [�;.�_« a �.. PE SC Received C ec Amount D to Permit) Invoice# Permft ID Code INFO Cash Remitted Service Request# Z s^ _ x.00 1212102 / ONSITE WASTEWATER PERMIT ,�/' � �ir,�� CC6iu• � �-sC � Fn �.aC'/`AUC, '�l�cr�"G.'f`.-l�—air"