Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTVENT ` 304 E WEBER AVE - 3" FL- STOCKTON CA 95202 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT ( CALL (209) 953-7697 FOR INSPECTIONS GEXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS (U 1 ]'�GC _CtTy1zIIP,] L/ PARCEL SIZE /J7bG�"�{�/1 <br />CROSS STREET _ N Li�L� j', All 1 3 J 2 fJ eV Z, <br />n ! <br />OWNER NAME PHONE <br />OWNER ADDRESS S G / CITYISTATFJZIP <br />CONTRAc,TOR IM <br />ADDRESS APfn Y4Chd C Z—ys CITYISTATEIZIP <br />LICENSE ❑ C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE .1 <br />WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X y <br />❑ PERC TEST # j I BUILDING PERMIT# LAND USE APPLICATION# <br />TYPE OF WORK: �❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIG DIALTERNATIVE <br />6! REPLACEMENT ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: x,r kESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS::NUMBER OF : PLOYEES: <br />�k-SEPTIC TANK TYPEIMFG le ,j -Z- CAPACITY I(. (Xr_ gal OF COMPARTMENT <br />LI GREASE TRAP TYPE MFG CAPACITY gal # OF COMPARTMENTS <br />LIPKG TX PLANT DISTANCE TO NEAREST: WELL ( R FOUNDATION ��% PROPERTY LINE <br />L3 LIFTSTATION SIZE- TYPE OF PUMP ❑ SAND L SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br />R PROPERTY LINE <br />DISTANCE TO N EAREST <br />WELL <br />❑ FILTER BED <br />WIDTH <br />R LENGTH <br />DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />❑ MOUNDED <br />WIDTH <br />R LENGTH <br />R PROPERTY LINE <br />DISTANCETONEAREST <br />WELL <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LEA <br />DISTANCE TO NEAREST <br />WELL <br />�7 SEEPAGE PITS <br />NUMBER <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL <br />LENGTH OF LINES <br />ft <br />R PROPERTY LINE <br />ft <br />DEPTH <br />R <br />ft PROPERTY LINE <br />R <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />R <br />DEPTH <br />ft <br />R PROPERTY LINE <br />ft <br />DEPTH <br />ft <br />R PROPERTY LINE <br />R <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AN THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RUT, AND REGULATIONS OF SAN JOAQUIN COUNTY, <br />MINIMUM 24 HOUR ADVANCE NOTICE RF. [RED FOR INSPECTIONS- PLEASE CALL (209) 953-7697 <br />SIGNED TITLF,_ M jke,r +' /` DATE <br />.Application Accepted By Li <br />Final Inspection By <br />ti <br />A <br />0 <br />0 <br />J <br />DEPARTMENT T. ONP, /� <br />r, Date Area �/ Employee 10# <br />Date ❑ SPECIAL PERMIT - Approved by /j y <br />42-0112003 01 <br />12.'228ONSITE WASTEWATER PERMIT <br />