Laserfiche WebLink
ONSITE WAS'I+e.YENATERIREATMENT SYST� PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTALHEA CI'II DEPARTMENT 304E V,--- A ""FL-"'C:'4TON CA 95202 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED y <br /> ryl/ /kII C ) ILUA L� CITY/ZIPS P+ <br /> JOB ADDRESS � Y <br /> APN - -O� U Q" PARCELSIZE <br /> CROSS STREET <br /> OWNER NAME <br /> PHONE :^ <br /> CITY/SPATE/'LIP <br /> OWNER ADDRESS L PHONE �.p /,�VS-/23(,S <br /> CONTRACTOR <br /> I V) <br /> CITY/STATE/ZIP OC kTlJAJ � <br /> Q <br /> CONTRACTOR ADDRESS RIS- F- ryl�-,A1��I / �6�❑ <br /> NUMBER EXPIRATION DATE <br /> LICENSE ElCA2 ❑C-36 OTHER <br /> H GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> WATER TABLE DEPTH: l O _ Al 5 <br /> PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> ❑ REPAIWADDII"ION ❑ ENGINEER DF.NIGNFl)IAI:TF.RNA'1'IVE <br /> 'EYPE OF WORK: ❑ NEWINSTALLATION � <br /> ❑ REPLACEMENT ❑ DRS'I'RUC1'ION <br /> INSTALLATION WILL SERVE: <br /> EI RESIDENCE EI COMMERCIAL LlOi HER <br /> NUMBER OF LIVING UNITS: NUMBER OF EMPLOYEES: <br /> N UMRY:k OF BEDROOMS: <br /> ❑ SEPTICTANK TYPE/MFG CAPACrry gal #OI'CUMPAk'I'MEN"I'S <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL It FOUNDATION If PkOPERTY LINE It <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 R FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH D LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL D FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft <br /> DiSTANCETO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREB C RTIFY THAT I HAV REPYEDTIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCESE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MU 2ADVANCE NOTICE:REQUIRED FOR INSPECIIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE CiTA3-1LrNi-F-eZ DATA ALT ��.jC�r��S <br /> --------------- <br /> �` <br /> � »mo- J d"bro-rs <br /> PPYE_ <br /> r ` wuaa�" �i iiyyjj . I I REC� ra <br /> IT T <br /> / FJd' TMvww�-rAy I E@3 i- I <br /> �4 PARCEL 3M f-- <br /> AU°3'drwY... m'Prn's <br /> ENVI <br /> rm PIR?!) I P..en rsreafAF1 <br /> PARCEL <br /> Taw <br /> M)FMa.T 1-2iM1UMIr <br /> R ^_ 'I'A lvwaL: T S/i f(Ira m'eAaerinm-� <br /> YinaY AYtK i,. �I UNtrT'I RR LYiSi, <br /> SRR la. l ,(�— `• 1 W. <br /> r rw. LIS- <br /> � IS ta, " ,nr <br /> E l� I, e�uer�-rT.r muo I '.�fffirv°' <br /> i I�� <br /> m-r.o-a <br /> DEPARTMENT USE ONLY 3� <br /> Application Accepted B 10 -16 - 03 Date Arca � 1/ Employee ID# <br /> Final Inspection B Date /0 -/;?- �23 ❑ SPECIAL PERMIT-Approved by I <br /> Character of Soil to Dep6 of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS ✓.;)832 <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By AM Remitted Service Re uest.# <br /> z 52- // 3 - to Roo 35�� <br /> 42.01-001 I 11 <br /> 12/2/02 ') ! // ONSITE WASTEWATER PERMIT <br />