Laserfiche WebLink
_ - /0.3� - <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT- / p CALL 209 953-7697 FOR INSPECTIONS" -- -EXPIRES 1 YEAR FROM DATE ISSUED <br /> �7h,-.,JOB ADDRESS 73 —YY- /t IO !1�. - - _ - CITY/ZIP 2O <br /> /I� <br /> CROSS STREET M Q n 7` /')L Y APN ('/./- 7 yo--Zo PARCEL SIZE a C, p <br /> OWNER NAME • , L , PHONE <br /> OWNER ADDRESS 7-5- 1/ e CITY/STATFJZIP 1- ({ t-d/O 6,4 qV ZJ�3/3 <br /> 0 <br /> CONTRACTOR_ W h C✓ Gil G t PHONE (0 2 <br /> I <br /> CONTRACTOR ADDRESS - - _ - _ - _ CRY/STATEIZIP <br /> I <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> i ❑ PERC TEST' # - BUILDING PERMIT# ZrO-'0702-Llq LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE. <br /> ❑ REPLACEMENT" - 1❑ DESTRUCTION <br /> I INSTALLATION WILL SERVE: _ -RESIDENCE ❑ COMMERCIAL ,❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: !� NUMBER OF EMPLOYEES: <br /> ( 14 SEPTIC.TANK TYPEIMFG 'I. I P1/ - .CAPACITY, I V�� .gal #OF COMPARTMENTS - — .1 <br /> /❑'GREASE TRAP) 'TYPFJMFGi CAPACITY11, gal, #OF COMPARTMENTS_ <br /> ❑ PKG TX PLANT ` DISTANCETO NEAREST: WELL • /ft FOUNDATION ft PROPERTY LINE ft <br /> El LIFT STATION SIZE TYPE OF PUMP l•, -,❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> •', ^� <br /> ( ,p (A; <br /> 1 }Ol LEACH LINES_,- LEACHING CHAMBERS rr a , #OF LINES LENGTH OF LINES U O • R �, <br /> DISTANCE TO NEAREST WELL FOUNDATION ft, PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST -WELL- --- R FOUNDATION?1,. I R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R _LENGTH ft DEPTH R x <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE .. ft li`\ll <br /> C3SUMPS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY L14E ft <br /> ❑ DISPOSAL PONDS WIDTH i �@ LENGTH' ' _ - ft DEPTH ft <br /> I DISTANCE TO NEAREST] F-WELL. ft,FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> 4 - ' <br /> I HEREBY CERTIFY THAT I-HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE-LAWS ANn. AND,REGULATIONS OF SAN JOAOU IN COUNTY. <br /> 4 - l -T-zn"J AYM3A%dFl �1v iX3 R <br /> SIGNED <br /> /ExlSTw6 P°a <br /> dT <br /> �aGao 0 <br /> � 1 <br /> k. <br /> cc <br /> � � �= g°' \ \ 4�/...�ae• ems: <br /> r � _ 'O✓YNd%nlONV/�i✓M3n/YO �N/L5/%3 -_ <br /> Application A_.,,.,-o "'„ "-.-Dat-e-� Arca Employcc ID# <br /> Final Inspection By Date DateJ,y�/U�' ❑.SPECIAL PERMIT Approved by <br /> Character of Soil to Depth o1`3 Ft: /- PiUSu�mp Soil Character: <br /> COMMENTS DLA L,07-OF AFCoaQZ <br /> r l <br /> PE SC Received C Amount Date Permit/ Invoice# Permit ID#- <br /> Code INFO B - Cash Remitted. --Service R uest# <br /> 14213 tf? se-✓t} Ops eti <br /> 42.02-001 - - - - •— --- --- -- - - - ONSITE WASTEWATER PERMIT <br /> 1 2122,12003 <br />