Laserfiche WebLink
4 <br /> O <br /> ONSITE WAL.- <br /> WATER TREATMENT SYSM PER t <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3N"FL-STOG -TOM 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT ++77 r CALL 209 953-769.7 FOR INSPECTIONS EXPIRES X YEAR FROM DATE ISSUED <br /> JOB ADDRESS vC �/ CITYIZIP G <br /> CROSSSTREET APN <br /> y <br /> j• , 1"�'1 - Q PARCEL SIZE p <br /> � W V <br /> O <br /> OWNER NAME C PHONE rMIni <br /> OWNER ADDRESS CITYISTATEIZIP <br /> CONTRACTOR C3 PHONE <br /> CONTRACTOR ADDRESS l CITY/STATE/ZIP 6 Z <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC,TEST . # BUILDING-PERMIT# LAND USE APPLICATION# +' <br /> TYPE OF WORK: ❑ NEW INSTALLATION ' ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> Q REPLACEMENT Q DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION. SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH 4' ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> I 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 HOUA ' OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 j <br /> SIGNED TITLE I✓��� ftp DATE <br /> V <br /> /x/ <br /> N. <br /> I <br /> v � <br /> f <br /> O <br /> PARTMENT SE <br /> Application Ac pted B Date Z ( r Area Employee ID# 9 <br /> Final Inspectio LBy Date ❑ SPECIAL PERMIT-Approved by I <br /> Character of Soil to Depth Jf 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS / <br /> PE SC Received Amount e DatPermit/ <br /> Code # Permit ID# <br /> Co�d7e INFO Casts Remitted at Service Request# <br /> f� rG <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />