Laserfiche WebLink
+ <br />n <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT �� 3 <br /># OF LINES LENGTH OF LINES it <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 304 E WEBER AVE - 3"° FL - STOCKTON CA 95202 - (209) 468-3420 <br />DISTANCETON AREST WELL <br />1 NON-REFUNDABLE PERMIT CAL-7697 FO hSPECTION:ti ]EXPIRES 1 YEAR FROM• DATE ISSUED <br />BED,y <br />JOBADDRESS <br />�S <br />.i Q �J� e 1 CrrYIZIP ! 2•J <br />n �FILTER <br />// v <br />CROSS STREET <br />Fy�— <br />C> 0— <br />APN 104 - 3aD -O PARCEL SIZE <br />p <br />OWNER NAMEG <br />%/�T�/PH�OeNE <br />o <br />OWNERADDRESS <br />/V CITY/STATE/ZIP Y'T✓/ �Sy Z - <br />❑ SUMPS <br />CONTRACTOR <br />/J ��f/G PHONE 3b P <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE R <br />❑ DISPOSAL PONDS WIDTH It LENGTH <br />CONTRACTOR ADDRESS <br />CITY/STATE/ZIP <br />"OTHER <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />LICENSE -42 <br />Cl C-36 NUMBER + EXPIRATION DATE <br />DISTANCE TO NEAREST WELL <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />(�� <br />�J <br />❑ PERC TEST # <br />BUILDING PERMIT # LAND USE APPLICATION # <br />SIGNED <br />TYPE OF WORK: <br />NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br />❑ REPLACEMENT ' ❑ DESTRUCTION= <br />INSTALLATION WILL SERVE: efRESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />yG� <br />TYPE/MFG 4eAe ' l -r- -!5LC1G% CAPACITY gal # OF COMPARTMENTS_ <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY _ pl # OF COMPARTMENTS <br />❑ PKG TX PLANT <br />DISTANCETONEARESr: WELL R FOUNDATION ft PROPERTY LINE ft <br />` <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES it <br />DISTANCETON AREST WELL <br />ft�F�)JUNDATION ft PROPERTY <br />LLIINNE• R <br />BED,y <br />WIDTH# ft LENGTH <br />J R DEPTH ft <br />n �FILTER <br />// v <br />DISTANCE TO NEAREST WELL <br />n �: <br />ft FOUNDATION -ZJQ ft PROPERTY LINE 2bft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />R DEPTH R <br />DISTANCE TO NEAREST WELL <br />R FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE R <br />❑ DISPOSAL PONDS WIDTH It LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />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 <br />ORDINANCES, STATE LAWS AND RU,LLESt AND REGULATIONS OFSAN JOAQUIN COUNTY. <br />P INIMU� Y® CEW1o'FICE SPEC 10N5 -PLEASE CALL (209)9?; -DATE <br />SIGNED <br />%'�Lp�' S Ae>. <br />TITLE <br />Application Ac pted By <br />Final Inspectio <br />Character of Soil to Depth ofj Ft: <br />COMMENTS "-D 1,eTr /10'-' 137CdJ <br />INFO <br />,RTMENT SE LY !�J <br />Date 11 <br />Area Employee ID#� •` <br />Date �.��OG ❑ SPECI�RMIT-Approved by <br />Pit/Sump Soil Character: r �-rW <br />DateI Permit[ Service Request i Invoice # I Permit 1D# <br /># I <br />42-02-001 ONSITE WASTEWATER PERMIT <br />1222(1003 <br />