Laserfiche WebLink
00 <br /> ONSITE WASTEWA' -R TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENT-A.HEALTH DEPARTMENT600 E MAIN STREET-STOCKTON CA;A,,�!-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL{2953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS fty��___�i j &Ve-,7 4!/GT�V /� CIITYIZIPP}y1-DDI y ^ 3'/� �+ <br /> CROSS STREET 1 GJ4riV <br /> LAI� !ZI> APN Q�f�l W `� O� PARCELSIZE c% <br /> OWNER NAME LFfFKEDD S={ riFuADv_�,7u-->- PHONE 74-5 - L��7b�4 y <br /> OWNER ADDRESS /7O� ON�D- CITYISTATEIZIP f.!GT �.ft /Sld 3 Z w <br /> CONTRACTOR LhT—F-�SAJEY e-01VfLL4%1A1 . PHONE �r�-14u3 <br /> CONTRACTOR ADDRESS p 13 0"4 :?,7��- CITYISTATEIZIP T Lf lZ L-.C7(_C� LSA YST.0/ <br /> LICENSE OC42 13C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: N 7 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# al <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAWADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> © REPLACEMENT E DESTRUCTION <br /> INSTALLATION WILL SERVE: El RESIDENCE U COMMERCIAL © OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERLY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES E LEACHING CHAMBERS #of LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft \t <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY-kNE ft G <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST_ WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ SEEPAGE PITS NuMarR WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft- PROPERTYLJNE ft <br /> I HEREBY CERTIFY THAT 1 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 /> �°/�y M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED A� TITLE�sVJE�Zo DATE <br /> `\ <br /> \"Ix <br /> Nn <br /> IY <br /> hj <br /> yr N p <br /> T <br /> r <br /> DEPARTMENT USE ONLY <br /> Applicatio Accepted Date %��C3/� Area Employee ID# <br /> Final Inspe Date �i�/��C 11 SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep 3 t: Pit/Sump Soil Cha r. <br /> COMMENT <br /> PE SC Received Check Amount Date Pe' i) Invoice# Permit ID# <br /> Code INFO B as Remitted Service Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1614107 <br />