Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUWY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3-FL-STOCKTON CA 95202 -(209)46&3420 <br /> NON-REFUNDABLE PERMIT CALL 209 95J-7697 FOR INSPECTIDNN EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS /31 fr f �r�rxwe--r'�vc/r CST R� 1'Y� .cfl�rY2le /.>/' <br /> CROSS STREET Etc klenbu 2'rn APN&4!420-0 3 PARCELSIM <br /> OWNER NAME MI•`� JYAI/LJ PHONE <br /> � I .y� <br /> OWNERADORESS CIN/STATF/ZW <br /> IP VI <br /> CONTRACTOR PHONE 7 <br /> t CONTRACTORADDRESS Cm/ST'ATEMP <br /> ` LICENSE C-42 Ll C-36 OTHER NUMBER EKPIMTONDATE <br /> WATERTABLE DEPFH: ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST # RUILDINC PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: O NEWINBFALLAT1ON Ilk REPAIR/ADDITION ❑ ENGINEER DESIGNEDIALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATIONWILL SERVE: 13 RESIDENCE 13 COMMERCIAL ❑ OTHER <br /> NUMBEROF LIVINGUNTS: NUMBEROFBEDROOMS: NUMBEROFEMPLOVEES: <br /> ® SEPTIC TANK TYPE/MFG G11A+L CAPACITY /LLI'J Rel #OFCOMPARTMENTS 7- <br /> * <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gel If OF COMPARTMENTS <br /> ❑ PKG TX PLAW DISTANCETONEARM: WELL,9PY R FOUNDATION 4S' R PROPERTYLINE /eO' fl <br /> ❑ LIFT STATION HIM- TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSPD SYSTEM) <br /> Ia LEACH LINES ❑ LEACHING CHAMBERS #OF LINES_ LENGTH OF LINES LID fl <br /> DISTANCETONEAREST WELL )lC fl FOUNDATION iL' R PROPERTY LINE 41�E fl <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCETONEAREST WELL fl FOUNDATION R PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH R <br /> DISTANCETONEARETT WELL It FOUNDATION R PROPERTY LINE ft `- <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH ft <br /> DISTANCETONEAREST WELL R FOUNDATION It PROPERTY LINE R <br /> 0( SEEPAGE PITS NUMBLRI WIDTH ?L" R DEPTH n, ' R <br /> DISFANCETONEAREST WELL /U'L' R FOIMDAMN // R PROPERTYLIHE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM N HOUR ADVANCE NOTICE REQUIW D FOR INSPECTIONS-PLEASE CALL(2D9)953469) <br /> SIGNED TITLE /hn-� DATE '9/6 <br /> y <br /> c <br /> N <br /> DEPART - .. - <br /> APPllwDa <br /> don Acee mt. My Employee IDN _ <br /> Flnallnepecfion DaM 1 ❑ S AL PERMIT-M�roved by <br /> n _ <br /> Chacter of SoitWDepth j.fb IHSump Soll Chander. <br /> COMMENTS <br /> PE SC Received Checldl/ Anwuvf Permit/ <br /> GOde INP) B F ReM0 1 Date Service R asst p 90 <br /> In In p Permit ID# <br />