Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> �'AN JOAQUIN COUNT-,ENVIRONMENTAL HEALTu DEPARTMENT3D4 E WEBER AVE-3Y°FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-717 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS /J CrrYJZIP Gea _ <br /> CROSS STREET y Al"O 3 0 _0 PARCEL SIZE � e <br /> OWNERNAME iL�1 �y /T Q•L/��� �1 �,r/_ - �_ ���_���� PHONE <br /> OWNERADDRESS '�aA `vL CITVISYATEJZIP /yJ� �7]IJ[, G <br /> CONTRACTOR /✓�/ 1 9 [7-�Vr PHONE /V' /' �r _vl1 <br /> CONTRACTOR ADDRENS�� ��W w- - � CITY/STATE/ZIP V <br /> CTI <br /> LICENSE LIC42 ❑C-36 OTIIER __ NUMBER �Y�7 E%PLRATION DATE_ <br /> WATER TABLE DEPTH: G� r 'r fl GFOCRAPH ICAL INFORMATION: Coordinates X Y- <br /> ❑ PERC TEST(S) NUMR[R LAND USE APPLICATION N <br /> TYPE OF WORK: NEW INSTALLATION L REPAIR/ O ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER Q1 <br /> NUMBEROF LIVING UNITS:_ NUMBEROF BEDROOMS: ` NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG , L-'� CAPACOY \Z�a gal 40FCOMPARTMENTS a <br /> ❑ GREASE TRAP TYpr/MFG CAPACrFY gal N OF COMPARTMENTS_ t <br /> ❑ PKG TX PLANT DISTANCE TO NEARERr: WELL ./�-"o / ft FOUNDATION . ft. PROPERTY LINEC�200 / R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENcLoI�sFF/joSvsTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS b of LINES c'-_ LENGTH OF LINES `y0 / ft <br /> i <br /> DISTANCE TO NEAREST Wk!. a ft FOUNDATION `1-D � H PROPERTY LINE_!�40 R Q <br /> ❑ FILTER HED WIDTH ft LENGTH H DEPTH ft 0. <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION_ ft PROPERTY LINE ft <br /> ❑ SUMP$ WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION_ ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WLDTII _ft LENGTH ft DEPTH 0 <br /> DISTANCE TO NEAREST WELL ft FOUNDKFON ft PKOPERIYLINE <br /> SEEPAGE PITS WIDTH " fl LENGTH / ft DEPTH �S ft <br /> DISTANCE TO NEAREST WELL 357-0y <br /> a ft FOUNDATION � ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE.PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE I AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI tl M ADVA fiICE REQUIRED FOR!NSP .TIONS-PLEASE CALL(209)953-7697 q` <br /> SIGNED TITLE Z <br /> DATE �- J b <br /> i <br /> 5 <br /> 16 00 <br /> AD I <br /> IV r3 <br /> d) <br /> BEI( HL LII 5E G <br /> hDEPARTMENT USE O <br /> Application Accepte�' U,e a. Dalci'1 3 Arra t F,mpinyee lDN_ <br /> Flnal Inapeetlon Date ❑ SPECIAIPERMIT.Appro,ed by <br /> Character of Sol{tr,Depth of Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE I SCReceived hec Amount ate PermiU InvoiceA Permit 1D# <br /> Code INPO C■sh Remitted Service Request <br /> rl <br /> 3 320 0035423 <br /> 42-01-001 <br /> 121102 ONSITE WASTEWATER PERMIT <br />