Laserfiche WebLink
1 '' 3.o <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3Y° FL- STockTON CA 95202 - (209) 468-3420 <br />INUIN-KEFU14DABL//Ell rEHMIT <br />ILA[,[, ILOY 913-7697 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />fO II 7,y •REI <br />V E CITY/ZIP <br />L i N Dit M _ <br />CROSS STREET[�PP�,IRdP-(7 <br />fI] <br />L„I <br />d <br />APN I1 ���� <br />�- PARCEL SIZE <br />OWNER NAME <br />AUU6.5 <br />Y, E Y -51PR U <br />A <br />.5Jy/J��1, �J� <br />PHONE A17!�P,6 <br />OWNER ADDRESS <br />Z�40 SZ NIGHDC,S <br />�C�J-� CITY/STATF/ZIP� <br />//.(/' <br />CA 9(p 3� <br />CONTRACTOR <br />INSTALLATION WILL SERVE: RESIDENCE <br />❑ COMMERCIAL ❑ OTHER <br />PHONE. 20 <br />CONTRACTOR ADDRESS <br />_ _ <br />CITV/STATrIZIP <br />LICENSE ❑ C-42 <br />❑ C-36 OTHER <br />NUMBER YgM I EXPIRATION DATE _ <br />WATER TABLE DEPTH:_ <br />R GEOGRAPHICAL INFORMATION: <br />Coordivates X _ Y <br />❑ <br />PERCTEST # <br />_ BUILDINGPERMIT# <br />--070.3oAW LAND USE APPLICATION 0 <br />TYPE OF WORK: <br />NEW INSTALLATION ❑ <br />REPAm/ADDrr1ON O ENGINEER DESIGNED/ALTERNATIVE <br />❑ REPLACEMENT <br />. ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: Z2 NUMBEROF EMPLOYEES: <br />SEPTIC TANK <br />TYPE/MFG�' eAIV[,r �O <br />CAPACITY I S Sal # Of COMPARTMENTS r- <br />❑ <br />GREASE TRAP <br />TYPElMFG_ <br />CAPACrry gal # OF COMPARTMENTS <br />❑ <br />PKC TX PLANT <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION _ R PROPERTY LINE R <br />❑ <br />Lin STATION <br />SIzE TYPE OF PUMP <br />_ O SAND OIL SEPARATOR (ENCLOSED SYsrrm) <br />It <br />LEACH LINES <br />❑ LEACHIVCCHAMHF.RS <br />NOFLINES LENGTH 4D <br />OF LINES R <br />_,;k/P <br />DISTANCE TO NEAREST WELL, ! SD (i FOUNDATION Te ft PROPERTY LINE 'ZOO" _- _R <br />O <br />FILTER BED <br />WIDTH ft LENGTH <br />_ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />fl FOUNDATION ft PROPERTY I.NE ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH fl <br />DISTANCETONEAREST WELL_, <br />ft FOUNDATION R PROPERTY LINE R <br />❑ <br />SUMPS <br />WIDTH R LENGTH <br />ft DEPTH R <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION R PROPERTY LINE R <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCETO NEAREST WELL <br />_ ft FOUNDATION' R PROPERTY LINE ft <br />54 <br />SEEPAGE PITS <br />NUMBER W-- <br />_ <br />"� / R DEPni 7;? -S / R <br />DISTANCE TO N EAREST WF.LI.� I? 'FOUNDATION ft PROPERTY LINE <br />1 HERF.RV CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQU IN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />M =VA <br />VAN .'OTICF. REQUIRED FOR INSPECTIONS - PLEAAF. CAI <br />SIGNED TITLE ®� <br />u AVE. 6t'7Rr1A AVE0 <br />N" <br />Application Accepted By _ ��^"'� Date77Z7,577Area <br />Final Inrpecttop By _ Date/5 Ll SPECIAL PERMIT -Approved b <br />Character of Soil to Depth or 3 Ft: PIUSump Soil Character: - <br />COMMENTS AJ ---J L-07—OF I _ iN/1-7/n'7- A-44,9.n.,,n AJIc1-i FI -4 77 <br />SC;PE <br />ode INPO2.t[ I(-7 <br />42.02-001 <br />12/222003 <br />v ,g 4 V <br />--'w��PITS <br />Amount PI <br />Remitted slate ICI <br />3`l GO <br />�so.c.il >s v <br />II• , <br />W SD <br />a` <br />SC;PE <br />ode INPO2.t[ I(-7 <br />42.02-001 <br />12/222003 <br />v ,g 4 V <br />eeldl/ <br />Cash <br />Amount PI <br />Remitted slate ICI <br />3`l GO <br />�so.c.il >s v <br />Invoice M <br />h <br />Y _ <br />u�o.Z <br />PermitIDb <br />ONSITE WASTEWATER PERMIT <br />