Laserfiche WebLink
ONSITEV6'ASTEWAT:ER TREATMENT SYSTEIVI <br /> FN E JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT,- - 304 WESER Ave-3"°FL-STOCKTON CA 95202 - (169)468-3420 <br /> � REFUNDABLE PERMIT CALL(2091 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> jr. ADDRESS /p 4600 lE1 ///ILLS CTTYIZIP UUooloylz 09f{y <br /> I v /fest*f <br /> €065STREET APN 01-7-7-39-08 PARCEL SIZE _ J`*t &r z a <br /> "ER NAME 4E5N PHONE <br /> F'ERADDRESS � CITY/STATE/ZSP '40Qri <br /> KIRACTORDILLOM 1�v�P PHONE -d16> _ <br /> INTRACTORADDRESS p ClrJ 2-I9c CITY/STATE/ZIP 2-.tW,- Z 64- Z?s -5�-/ �T <br /> ;uiCENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WA TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X �# Y <br /> PERC TEST(S) NUII�IBER �� LAND USE APPLICATION# 4 —5'3_�s <br /> I YPEOF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNAT€YE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> 4STALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ,GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS I <br /> PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> EACH LINES ❑ LEACHING CHAMBERS #OF LIES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 7 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DIsrANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> "" :MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> rQSUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ]= DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> -SEEPAGE PITS WIDTH ft LENGTH ft DEPTH ft I <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> THEREBY CERTIFY THAT II 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 /> M [MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGHED TITLE r7` DATE <br /> 75 <br /> IJ <br /> JE <br /> a; <br /> 3 I <br /> tl <br />