Laserfiche WebLink
13� ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUN MIT CALL 09 95_3-7697 FOR INSPECTIONS EXPIRES E FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP no-no '//► �_ <br /> CROSS STREET �� TRW N PARCEL SIZE G-�� o <br /> 0 <br /> 77 <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CITYlSTATElZIP L1��D 9 9�`'��'L�do� <br /> CONTRACTOR W242/415 ^ PHONE / ` <br /> CONTRACTOR ADDRESS I v ' 1LFN "— CITY/STATE/ZIP J <br /> '1005H <br /> LICENSE XC-42 1.. 36 OTHER NUMBER <br /> LICENSE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> U <br /> C] PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION FJ ENGINEER DESIGNED/ALTERNATIVE <br /> 13 REPLACEMENT Cl OUT-OF-SERVICE SEPTIC SYSTEM 1.1 DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 1-1 COMMERCIAL ( I OTHER O <br /> NUMBER OF LIVING UNITS: { NUMBER OF BEDROOMS: 2 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG V CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS <br /> r <br /> DISTANCE TO NEAREST: WELL 2M, — ft FOUNDATION_ ft PROPERTY LINE ft \\ <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) �J <br /> r <br /> LEACH LINES Y LEACHING CHAMBER 94 #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL + ft FUUNDATION ft PROPERTY LINE 40 ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUIDAFION ft PROPERTY LINE ft <br /> SUMPS WIDTH 2�ft LENC�T � 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 ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I 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 /> hwmHQUO A ' G&N2L1Qf= E UIRED FOR/hWfCTIONS E CALL 209 953-7697 <br /> SIGNED UVXj lLk UW U UV TITLE DATE <br /> i <br /> vL <br /> DEPA RTMENTtSEONLY <br /> Application Accep Date � Area � Employee ID# <br /> Final Inspection 8y l i Date _ F SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: Pit/ ump Soil Character: <br /> COMMENTS 2 v t `- <br /> <Za <br /> Iz Alp <br /> PE S Receivedheck#, Amount Permit/ <br /> Code INFO B s Remitted /Date Service Request# Invoice# Permit ID# <br /> S <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 9!21/10 �(P <br />