Laserfiche WebLink
QNSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBFR AVE -34°FL-STOCKTON CA 95202 - (209)469-3420 <br /> NON-REFUNDABLE <br /> /PERMIT CALL(^f209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOitADDRESS 7u1iV U[L L CITYIZIP iAlp <br /> CROSS STREET L D 1? l iAPN (2T 3 117�k)e in l en PARCEL SIQ leg—,'l o <br /> OWNER N.AMF. 'j <br /> OWNER ADDRESS CITYISTATEIL.IP_ e es V405" <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITYISTA7F"IZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER _ NUMBER EXPIRATION DATE_ 10 <br /> WATER TABLE DEPTH: ft CEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # WILDING PERMIT## LAND USE APPLICATION U <br /> TYPE OF WORK: LJ NEW INSTALLATION R£PAIRIADDITION ❑ ENGINEER DF,SIGNED/ALTERNATIVE <br /> REPLACEMENT DESTRLCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL <br /> ��// ❑ OTHER <br /> NUMBEROF LIVING UNITS: fz NUMBER OF BEDROOMS: !! NUMBER OF EMPLOYEES: --4P-^ <br /> SEPTIC TANK TYPE/MFG6- y CAPACITY LJ gal #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY _ gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE.TO NEAREST: WELL. IL FOUNDATION PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH F � i OE LINES LENGTH OF LINES ft <br /> �`� 'ELL ftFOI:NDA7'IQ\ i�'-` ft PROPERTY LINE. �1 _ ft <br /> ❑ FILTER fy� ft LENGTH _ i_tt DEPTH _ fl <br /> 'ELL ft FOUNDATION ft PROPERTY LINE Q <br /> ❑ MOUND V w �lJa ft LE,NGTH_ n DEPTH ft <br /> TELL ft FOUNDATION tt PROPERTY I.INE ft <br /> ❑ SUMP5 f R LENCEtI Ft DEPTH ft <br /> Ft FOLNDATiON ft PROPERTY LINE ft <br /> ❑ DISPOS. ft LENGTH_ _tT DEPTH <br /> DISTANCE TO NEAREST WELL /50+ ft FOU`'DATION /Q •- _ ft PROPERTY LINE :.? ft <br /> SEEPAGE PITS NUMBER WIDTH_ .�� �, ,• _ _Ci DEPTH <br /> DISTANCE Tp NEAREST WELL�_Q_Q ft 'FOUNDATION " ft PROPERTY I.INE R <br /> HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE;IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE.REQUIRED FOR INSPECTIONS-PLEASE CALL f2Q9)953-7697 <br /> SIGNED I TITLE_ DATE <br /> r <br /> Tr I Wei <br /> JOA00 Ur, <br /> i <br /> 7j C. - 1R N E TA.. <br /> o Il' <br /> I#Z): <br /> �. rr,�? <br /> DEPARTMENT U E O .Y <br /> Application Aecepced ByV Date Area �_ Employee ID4 <br /> 7177 <br /> Final Inspection,By �� � y Date J �� ❑ SPECIAL PERMIT-Approved by _ <br /> Character of Soil to Depth of 3 Ft; PiUSump Soil Character: 1117 <br /> COMMENTS - <br /> JrAA <br /> FIE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By r Cash Remitted <br /> 21w zz 000�3 �� ONSITG WASTEWATER PERM] <br /> JI � r /S7i L L_/fir!�G' deJ tt� w 5'+i�F�yl l <br /> T <br /> 12r22;2O003 � t�l2Gy''�'�; ��I<+�-� <br />