Laserfiche WebLink
`I 00 <br /> DOUNTY <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQI# ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"9 FL-STOCKTON CA 9$202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 53-7.697 FOR.INSPECTION5 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/zIP ��� <br /> APN 007 20 PARCEL SIZE <br /> GROSS STREET - <br /> k <br /> �J PHONE � <br /> OWNER NAME n i. Pte,, <br /> r I <br /> �I CITYISTATEIZIP , <br /> OWNERADDRF.SS / <br /> CONTRACTOR G i ,PHONE _ <br /> CONTRACTOR ADDRESS 'c— CITY/STATE/ZIP G a <br /> i <br /> LICENSE C-42 ❑C-36 OTHER i NUMBER Vl;:S/J _.__ EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ •PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ❑ ENGINEER DESIGNED(ALTERNATIVE <br /> { - ❑ DFSTRUC7'ION <br /> ❑ REPLACEMENT `' I <br /> INSTALLATION WILL SERVE: RESIDENCE E) COMMERCIAL ❑ OTHER <br /> p NUMBER OF LIVING UNITS:" it _ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> al #OF COMPARTMENTS <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY a <br /> ❑ ;GREASE TRAP TYPE/MFG1 <br /> - CAPACITY gal #OF COMPARTMENTS I <br /> is • <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL i ft FOUNDATION ft PROPERTY LME ft <br /> ❑ `LIFT STATION SIZE TYPE OF PUMP <br /> ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> f i # LINES LIO ft <br /> LEACH LINES 13 LEACHING CHAMBERS OF LINES LENGTH OF- L- <br /> LLrr I DISTANCE TO NEAREST WELL �O I ft FOUNDATION �S _R PROPERTY LINE �2) t ft <br /> ft DEPTH <br /> L1 FILTER BED <br /> WIDTH ft LENGTH ` _ fl <br /> __. ft FOUNDATION ft PROPERTY LINE <br /> DISTANCE TO NEAREST WELLft <br /> ❑ MOUNDED . WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 1 ft FOUNDATION ft PROPERTY LINE ft <br /> El SUMPS WIDTH ft LENGTH I ft DEPTH ft <br /> f DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> �. <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH 8 v <br /> DISTANCE TO NEAREST' WELL $ FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER <br /> WIDTH � ft DEPTH _�S ft <br /> s: DISTANCE To NEAREST WELL �7SIi ft FOUNDATION /CIO ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATIQN AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> .I <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUiN COUNTY: I <br /> c* .! MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS–PLEASE CALL(209)953-7697 <br /> TITLE DATE o� <br /> �SIGNED <br /> I <br /> 1 <br /> 1 <br /> L� 1 <br /> U <br /> f e PI <br /> I' <br /> 4 <br /> 1 G b p ►� <br /> i <br /> j4p S �! n- ul <br /> I14 r <br />