Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT - 304E WEBER AVE-r"FL- ����{I x-3421) <br /> NON-REFUNDABLE PERMIT CALL(209)953-769'1 FOR INSPECTIONS EXPI�3PA0�ISSUED <br /> ' JOB ADDRESSIA41 00 At PtLENE CITY/Z1P <br /> r <br /> yt / '% i <br /> CRUSSSTREET APNPJ. �/ Pat) PARCELSIZE�, b <br /> OWNERNAME :-. C� .i n -- PHONE <br /> I <br /> OWNERADDRM t" J CITYISTATE(ZiP <br /> CONTRACTOR r� PHONE <br /> CDNTRACTOR ADDRESS CITyMrAT L7AP <br /> LICENSE Cl C42 ❑C-36 OTHER NUMBER EXPIRATIDN DATE <br /> WATERTABLEDFrMi R GEOCRAPHICALINFORMATION: CoarQipatea % Y r <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION 0 <br /> TYPE OF WORK: 0 NEW INSTALLATION )b. REPAIRIADDITION [3 ENGINEER DESIGNED!ALTERNATIVE <br /> U REPLACEMENT CJ DPSTaumoN <br /> INSTALLATION WILL SUAVE: > -iDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OP LIV ING UMITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> Q SEPTICTANK TYPElMfO CAPACITY gel #OF COMPARTMENTS <br /> [3 CREASE TRAP 7YPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG T7(PLANT DISTANCETO NEAREST: WELL ft FOUNDATION R PROPERTY LINE It <br /> U LIFT STATION SIZE TYPE OP PUMP ❑ SAND 031,SEPARATOR(ENCLOSFD SYSTEM) <br /> LEACH LINES O LEACHING CHAMBERS #oPLares�•__ LfNGTH OFLINEs,� 7 A _ R ` <br /> c DISTANCE TO NEAREST WELL I.--ft FOUNDATION j i R PROPERTY LINE <br /> ❑ FILTER BED WIDSH R LENGTH fl. D€PTI! ft <br /> DwrANGETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R I <br /> U MOUNDED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCETONEARESP WELL ft FOUNDATION ft PROPERTY LINE ft <br /> pry I <br /> �. SUMPS wlmH_�_ft 1.EItG1'IE A, _ R DEPTH_' <br /> y DISTANCE TO NEAREST WELL ft FOUNDATION fA?S ft PROPERTY UNE R <br /> U DISPOSAL PONDS WROTH R u4w R DEPTH R <br /> DIBFANCETONEAREST WELL ft FOUNDATION ft PROPERTY UNE R <br /> 0 SEEPAGE PITS WIDTH ft LENGTH R DEM 'R <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUA HOUR ADVANCE NOTICE REQUIRED FOR FNS]PP�E}CTTONS-PLEASE CALL(209)953.7647 <br /> SIGNED TITLE dll A'Z,{, DATE1 <br /> v <br /> i <br /> 0 <br /> y <br /> Date rDEPARTME1N�-F1 2—"- <br /> "'•' S <br /> Emplaya ID#� <br /> APPltcation Acap[ed BAre, <br /> --- ' <br /> r. <br /> /�$~ ❑ SPECIAL PER IT-Approvr*dhV <br /> FinalIBrpectian Date <br /> CLaracler of SoEI to Depth of 3 R' PINSUMP Sail Character: — <br /> ONIMENTS pus �. t �$ .3r�r !©v ta.c� 1,.e ' r t <br /> PE SC Received Cis Ameunf bate Permit! <br /> Code Iwo B Remitted SeTvkeRe neat# _ - <br /> x.to IDs1ev "l 'goo 34,5 <br /> 47-01.003 ONSITE WASTEWATER PERMIT <br /> 120M <br />