Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMITtP t"O-170(p <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AvE.3-FL-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Gam• CITY/ZIP <br /> CROSS STREET !J-IlXWr`vL. APN (70 PARCEL SIZE p <br /> // 12-1r <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP X! 4 <br /> CONTRACTOR 'gr27✓ �j <br /> / 0 � % <br /> PHONE <br /> CONTRACTOR ADDRESS �' CrTY1STATEIZIP <br /> LICENSE G42 ❑C-36 OTHER NUMBER S EXPIRATION DATE <br /> WATER TABLE DEPTH: E6Io ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ErNEwINSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: G •NUMBER OF BEDROOMS: NUMBEROFEMPLOYEES: <br /> SEPTICTANK TYPE/MFG�. /Wf CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFO CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL �F!J r 4 ft FOUNDATION ft PROPERTY LINE /k5o�� tt <br /> ❑ LIFT STATION SIZE- TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 0 LEACHING CHAMBERS /0 t-2, f� #OF LINES LENGTH OF LINES 41b, , it pQ <br /> DISTANCE TO NEAREST WELL d + R FOUNDATION SD fl PROPERTY LINE 100 r f ft (14 <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl IKYU. <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH R <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 R PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH 3 CO�� it "ay; <br /> ft DEPTH v2 S t R <br /> DISTANCE TO NEAREST WELL �ft FOUNDATION Ic9y• 'I' ft PROPERTY LINE UC.1 ' 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 LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> /, <br /> ;��N.M OUR ADVANCE NOTICE REQUIRED FOR INSP IONS-PLEASE CALL(209)953-7697 <br /> SIGNED, TITLE DATE ✓+��-U/ <br /> ir <br /> )9V K <br /> ll- <br /> Nf <br /> '0 <br /> f- I; / <br /> 1A 1ITA <br /> xAffl4DEPARTV.F <br /> DEPARTMENT SE NLY n <br /> Application Accepted Date Z O Area ZI 1 Employee]D# s5!'+"Y <br /> Final Inspection By Date__ ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De of 3 Ft: PittSum Soil Character: <br /> COMMENTS . = �L� �-k- <br /> L z--45 IV: LYS V <br /> PE SC Received eck#/ Amount Date PermlU Invoice# Permit ID# <br /> Code INFO B s Remitted Service Request# <br /> 2.13 17 3Zo.00 koD "i ul� <br /> 42-01-001 <br /> 12/2/02 ONSITE WASTEWATER PERMIT <br />