Laserfiche WebLink
ONSITE WAWATER TREATMENT SYSTEM PER ��U�� <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH ,iTMEKT 304E WEBER AVE-3`"FL-STUCI ;-A 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)957-7697 FOR INSPECTIONS EXPIRES I/YEAR FROM DATE ISSUED <br /> e� <br /> �^ JOB ADDRESS ?•II CITY/ZIP <br /> CROSS STREET APN Z13��'—CYO-2-5 PARCEL SIZE c <br /> OWNER NAME '� / / •"� PHONE <br /> OWNERADDRESS CITYISYATFJZIP - <br /> CONTRACTOR , 0++ <br /> j PHONE <br /> CONTRACTOR ADDRESS / [fj�C/IT�Yl$TATEIZIPp��O� <br /> LICENSE -42 ❑C-36 OTHER NUMBER T T'T 7-Z—yr Vrt+ EXPIRATION DATE AD O NIA) <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COordinates X Y r <br /> F11—PE—RC TEST(S) NUMBER LAND USE APPLTCATION# VS <br /> ❑ <br /> TYPE OP WORK: �< NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> b! NUMBEROF LIVING UNITS: NUMBEROF BEDROOMS: NumlIcROFEMPLOYEES: <br /> SEPTIC TANK TYPE/MFG[- Nt G �41 CAPACITY /�5� <br /> gal N OFCOMPARTMENTS <br /> ❑ CREASE TRAP TYPElM FG � CAPACITY gal #OF COMPARTMENTS <br /> ❑ <br /> PKC TX PLANT DISTANCE TO NEAREST: WELL / / L� FOUNDATION _ PROPERTY LINE "fit/ f1 <br /> CI LIFT STATION SIZE TYPE OF—/� R R PU�-M�.PP ❑ SANG OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 1 � <br /> tl LEACH LINES 13 LEACHING CHAMBERS #OF LINES-� _ LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL FOUNDATION �ft PROPERTY LINE_ (! R <br /> ❑ FILTER BED WIDTH 5 LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION A PROPERTY UNE R <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH tl <br /> DISTANCETO NEAREST WELL ft FOUNDATION it PROPERTY LIKE it <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> F <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE tl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH - 11 <br /> DISTANCE TO NEAREST WELL�ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH R ft DEPTH .SGS _fl <br /> DISTANCE TO NEAREST WELL 121Q ft FOUNDATICN_ � Il PROPERTY LINE fl <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 /> MININIUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECT NS-PLEASE CALL(209)953-7697 <br /> SIGNED 'IV D/L. 7v ,.SIT LE DATE ��'- 0 <br /> Ii <br /> INS <br /> 3 <br /> �I O 4N L <br /> DEPARTMENT SE ONLY <br /> Application Acceptedj:gDate -3 Z3 d Area f q Employee ID# OL <br /> Final Inspection H Date J�-� - ElSPECIAL PERMIT-Approved by <br /> l' Character of Soil to De th of 3 Ft: Pi0SumP Soil Character: <br /> COMMENTS <br /> L's "Zer/ Axad'z _ ac •�7 <br /> PE SC Received hec Amount Date Permit/ Invoice# Permit lDN <br /> Code INPO B ash Remlited Service Re nest p <br /> If-7 1 J2 <br /> 1 y, 42-OI-001 <br /> P I 1212102 - 9� ONSITE WASTEWATER PERMIT <br /> if <br /> t <br />