SR0084372_SSNL - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3'0 FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED 7 ON 11 JOB ADDRESS Cl'I'Y/21>~ - = 6?F�CQ' 115 CROSS STREET APN � l �!`J-0 A- PARCEL SIZE�7o� Tao WM DA OWNER NAME /t I� ' /�]/1 PHpO�NE �J 4 - ( 1 OWNERADDRL.SS .4 A w P�i3 Q`�L f�Vey CITY/STATE/ZIP (JC�fLIcl�— --I � CJ Yr s^�+ CONTRACTOR •�-}- �/�3 1 v r V�I �� PHON' - '� 96 CONTRACTOR ADDRESS1 W W I LSC V v V C1TY7$TATE/ZIP('y1, l.� Jl t"') wLJ LICENSE XC42 ❑C-36 .O'T�HER - NUMBER J 1 EXPIRATION DATE t WATER TABLE DEPTH:�Q rr rat-rw ft GEOGRAPHICAL INFORMATION: Coordlndtes X y ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION I( REPAIR/ADDITION ❑ ENCINEERDESIGNF.DIALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER, NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal 4 OF COM PARTMEN IS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPFR'I'Y LINE } ❑ LIFT STATION SIZE TYPE OF PUMP 1 ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) XLEACH LINES LEACHING CHAMBERS�Q% 1 #OF LINES t _ LENGTH OF LINES' r fY DISTANCE TO NEAREST WELL 51t FOUNDATION �[„h tj PROPERTY LINE IBJ• ft JF ❑ FILTER BED WIDTH ft LENGTH it DEPTH J DISTANCE TO NEAREST WELL _ fl FOUNDATION ft PROPERTY LINE }� LI MOUNDED WIDTH ft LENGTH _fl ]DEPTH � ft DISTANCE TO NEAREST WELL ft FOUNDATION_ ft PROPERTY LINE ft ❑ sumps WIDTH ft LENGTII R DEPTH ft DISTANCE TO NEAREST WELL _ft FOUNDATION_ ft PROPERTY LINE fj ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ ft DISTANCETO�E9' IRIEST WELL ft FOUNllAT[�JN _ft PROPERTY LINEft SEEPAGE PITS WIDTH �jJp� ft LENGTH ft DEPTH Z5 }} DISTANCE TO NEAREST WELL O ft FOUNDATION + tZ PROPERTY LINE HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. Ml I U H U A VANCE NOTICE REQUIRED FOR 1,VV T4 NS Ltffl CALL(209)953-7697 �`} SIGNS {�/J� _ TITLE L DATE�B(nIy3 �1 r O 0 ! :1 EE rt � 4 �j f p gt1 H „< n� Y51f1 Application Accepted By. �.1 DEPARTMENT USE ONLY /} � �(�, Date 1 Area _j �J Employee ID#" Final Inspection By� J Date `J—Y��— El SPECIAL PERMIT-Approved by Character of Sail to De h o13 Ft: Pit/Sump Soil Character- COMMENTS PESC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B Remitted �. .H l7 3 i r o 3 3 42.01-001 12!2/02 ONSITE WASTEWATER PERMIT