Laserfiche WebLink
;,C - ONSITE WASTEWATER TREATMENT SYSTEM PERMITZeg <br /> t' <br /> OA'QUI." OUNTY ENY(RONMENTAE HEATH DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTOM4tjl95 <br /> NON-REFUNDABLE PERMIT ALL(209)953-76997 FOR 1N.SPECT:O,NS EX—Ft—1 YEAR FROM DATE ISSUED <br /> I —ll — <br /> FRROSSSTRELT //Y�1./"✓ f f-e APN.. C c3 — lsso—c PARC{L 512E Qi <br /> NAME p ��Tls� / A %1PHaNE <br /> ADDRESS CITYISTATFJZIP <br /> ` CONTRACTOR PHONE <br /> 1. CONTRACTOR ADBRF,SS CiTY2STAT£/ZIP <br /> LICENSE <br /> WATER TABLE DEPTDEPT ❑C-]6 OTHER NDM1IREN EXPIRATION DATE <br /> H: R GEOGRAPHICAL INFORMATION: CoordlR(t S X Y <br /> ❑ FERC TEST >t BUILb[NG PERMIT# S�j-as C5`r��_.E• SE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITIDN ❑ ENGINEER DESIGNED fALTERNATIYE <br /> ❑ REPLACEMENT ❑ DESTRUCITON <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEBROO.NS: NUMBER OF EMPLOYEES; <br /> SEPTIC TA NK TYPFIMFG % CAPACrTY � r�� grl p EFCOMPARTMENTS b- 2 <br /> /❑' GREASE TRAP TYPEYMFG CAPACITY VI q OF COMPARTMENTS <br /> Q PKG TX PLANT DumANCETDNEAREST: WELL R FOUNDATION ft PROPERTY LINE <br /> ft <br /> O LIFT STATION SlzE TYPE OF PUMP ❑rSAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES L] LEACHING CHAMBERS NOF UNES .S LENGTH OF LINES <br /> ft <br /> DISTANCETONEAREST WELL J,�� �J-F fl FOUNDATION_jam ft PROPERTY LINE `ft <br /> L3 FILTER HED WIDTH ft LEHGTH R DEPTH <br /> R ` <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE (1 <br /> ❑ MOUNDED WIDTH ft LENGTH H DEPTH <br /> DISTANCE TO NEARLST WELL R FOUNDATION {I PROPERTY LINE R <br /> ❑ SUh1Ps WIDTH.ft LEHGTH R DEPTH <br /> Ift <br /> DISTANCETO NEAREST WELL ft FOUNDATION <br /> R PROPERTY LINE <br /> nfl DISPOSAL PONDS upTx <br /> ft LENGTH <br /> RDEPTH <br /> 1 <br /> DISTANCE TO NEAREST WELL ff FOUNDATION H PROPERTY GINE R <br /> I SEEPAGE PITS NUM.ERw % R <br /> ft <br /> R <br /> DISTANCE TO NEAREST WELL <br /> LLf!q 0 FOUNDATION��1 fj DEPTH n / <br /> PROPERTY LINE R <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORKW ILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN 1OAQOIN COUNTY. <br /> MINIMUM I4 H/01J/1pADVAN NOTICE REQUt RED FORINSPECTIONS-PLEAS E CALL(209)953.7697 i <br /> SIGNED <br /> 111I -r-J �,1 TITLE DATE <br /> 1 <br /> 1 <br /> Y <br /> !( <br /> 5 NI N <br /> ' T D <br /> DEPARTMENT US O Y <br /> Appltca1lOn Accepted B Bate -� Ut' Are. Employee IDS8-7 <br /> Final Inspection By / / <br /> Dale ��y�� ❑ SPECIAL PE RMiT-App—ed by <br /> Chasactcr 9f Soil tO Der Of3 1; PiUSHmp SOLI Character: <br /> CGMMENTS o G= <br /> 2 <br /> PE SC Receic'ed Amount Date Permitl <br /> Code IF <br /> B• R—iticd Sen ice Re Hest p tep Permit IDk <br /> +a-iL 2sc t� G— 1 sr-o.0 3 2 f, 5f`C. S i Cj' <br /> 42.62-001 <br /> 1722200] ONSITE WASTEWATER PERMIT <br />