Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIlit, 9 t viz <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT \� 304 F.WEBER AVE-3-rL-STOCKTO SCON6,0420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS l"l S'so W-dk./o/«) C/�' cl"ly/$IP �j//G� •��,,n Cf' <br /> CROSS$TAFFY 1 or�/w J�Al(.v ✓��+ APY `�� •' PANCEL SIZEy�� o <br /> OWNER NAME f�rlla •r y{'C � /l—i <br /> OWNER ADDRESS I((}J'� -!'G���/U �i� CITY/STATFIZIP <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C42 ❑C-36 g131ER NUMBER _ EXPIRATION DATE _ <br /> WATER TABLE DEYI'H:__ ft GEOGRAPHICAL INFOWMATTON! Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION oA ❑ REPAIR/ADDITION (3 ENGINEER DESIGNED/AIAT:RNATIVE <br /> REPLACEMENT :3 &CM LI.F ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: O RESIDENCE O COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: NUMBEROFEMPLOYF.ES: <br /> SEPTIC TANK TYPEiMFG CAPACITY_ gal #OFCOMPARTMENTS <br /> _ <br /> ❑ GREASE TRAP TYPE%MFG CAPACII-Y gal #OF COMPARTME.NIS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION _ ft PROPERTY LINE _fi <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENc1.OSFD SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #oP LINES LENGTH OF LME$ It <br /> DISIANCE TO NEARFST WELL _ft FOUNDATION ft PROPERTY LME fl <br /> FILTER BED WIDTH_ 3a fl LE.,iom Vc7 R DEPTH ` ft <br /> DISTANCE TO NEAREST N'FLL_�Z _It FOUNDATION—_Lft QIY'PROPERTY LINE ft <br /> O MOUNDED WIDTH ft LENGTH R DEPITI ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ SUMPS W'IDrx ft LENGTH ft DEPTH_ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _it PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH_ _ tl DEPTH ft <br /> DISTANCE TO NEAREST WF.1.1. fl FOUNDATION fl PROPERTY LINE 11 <br /> ❑ SEEPAGE PITS NL:MBER WIDTH ft DEPTH_ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED'IIHIS APPLICATION AND THE WORK WILL BE DOVE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M{NIM1IUM 24 HO ANCL NOTICE REgUIRED FOR INSPECTIONS-PLEASE CALL 4209)953-7697 <br /> S1GNE L TITLE.^ DATE <br /> � 1 <br /> _ A <br /> _ if 1 -2111 <br /> 7 <br /> 1 <br /> DEPARTMENT US .N 36 � <br /> Application Accepted*of3Ft,: _ ate Arca Employs ID#�. <br /> Final Inspection By Date S ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Pit/Sump Soil Character: <br /> COMMENTS �!$X, tS ����ywd�.Ae pser�+l2 IYef <br /> PE SCReceived Cheeidl/ Amount Date Permit/ <br /> Code INFO 8 asb Remitted Service k uest# Invoice N Permit ID# <br /> Z c t bo I D of yZ <br /> 42.02-001 ONSITE WASTEWATER PERMIT <br /> 1222'2003 <br />