Laserfiche WebLink
I ) <br /> ONSITE WAS.. WA1VZ TREATMENT SYS'r..,EVI PEJ 1!y442,0 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT304 E WEBER AVE -3R°FL-STOCNON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM <br /> rOWNELIf3�r.Tt� ItpAD CITY/ZIP �sAL- H <br /> R <br /> ADDRESS ? /� n <br /> C APN U -I J J PARCEL SIZE <br /> OSS STREET �ACV V(� 11, pp <br /> 1 LL—C PHONE <FJ 1-61Li - L46L7� <br /> NAME AGF ICU DunnL. NvL,A(.'Gs AA <br /> GJi CAaLs " �VL1 ZIXJ CITY/STATE/ZIP MIhlNCT55305 <br /> NER ADDRESS 61 LI —L{ oo <br /> NTRACTOR U O ILI C)"I PHONE 6 <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE EI C42 L3 C-36 OTHER NUMBER .EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y _ \ <br /> ❑ PERC TEST Is BUILDING PERMIT# LAND USE APPLICATION# /4— GO <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> V ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> I ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <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 R DEPTH ft —1 <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R 'J <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft �11 <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE R yl <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH ft V <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH R <br /> w <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it UA <br /> 1 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPEC/TIONS-PLEASE CALL(209)953-7697 t4 <br /> SIGNED '� .0 TITLE A DATE <br /> "ccb <br /> s <br /> Us <br /> A <br /> F <br /> c <br /> DEPARTMENT PSE QNLY <br /> Application Accepted By Date Area Z( Z Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS - E"7tC '10jE'AAe f7— <br /> I <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ION <br /> Code INFO By Cash Remitted Service Request# <br /> 42.6 .� SP-00401M <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />