Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAI"STREDT-STOCIRON CA 95202-(209)440 A <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ,y/'r / rf�}t 9, E• l7-0 CrrrrzlP I PO H•) cl A y <br /> CROSS STREET �W r/�\rI-rT,N/GI.�r.� /� APN 2OS -U 1 v�+ 0 PARCEL SIZE�I&�OT�A�- C <br /> OWNER NAME / T--rM,((yj lJl�E.rJ.711'—VA PHONE "MIF��/TT <br /> ONNER AOORESS /s4 1 L!• Hw /Z& CITYISTATErzIP 112(P,N LA <br /> CONTRACTOR U✓E oAK PHONE 3oI - 03-7J <br /> - <br /> CONTRACTOR ADDRESS 4O'4 w• OAK J( • <br /> CITWSTATE21P Lo>( GA 9sZ'Tea <br /> LICENSE 1.1Cd2 QC46 OTHER NVNBER E%PIMTON DAT! <br /> WATER TABLE DEPTx: R GEOGRAPHICALINFORMATION: COOTEInateG X Y <br /> PERCTEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: LI NEWINSTALLAnox D REPAIR/ADDITION II ENGINSERDESIGNEOIALTERNADVE <br /> D REPLACEMENT 11 DESTRUCTION <br /> INSTALLATION WILL SERVE: fJ ResloeNcE I-I Co.... II OMeR <br /> NUMBER OF LIVING UNITS: NUMBEROFBsolocoMS: NUMBER OF EMPLOYEE:: <br /> ❑ SEPMCTANK TYPWMFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPHMFG - CAPAcT gal #OFCOMPARTMENTS <br /> DISTANCETONeaNEST: WELL R FOUNDATION It PROPERTY LINE 11 <br /> ❑ LIFTSTATION SITE TYPE OF PUMP D PKGTXPLANT O SANDOILSEPARATOR(ENCLOSEDSYSTEM) <br /> O LEACH LINES fl LEACHINGCHAMBERS #OFLINES LENGTHOFL.IBEB ft <br /> DISTANCETONEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTERSED WIDTH R LENGTH ft DEM it <br /> DISTANCETONEAREST N U- It FOUNDATION ft PROFERTY LINE ft <br /> ❑ MOUNDED WIDM it LENGTH it DEPTH ft <br /> DISTAncefONEAREET WELL _ It FOUNDATION it PROPERLY UNE It <br /> ❑ sumps Wm R LENGTH k DEM ft <br /> DISTANCETONEAREBT WELL R FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH ft Depni it <br /> DISTANCETONEARSW WELL ft FOUNDATION it PROPERTYLINE R <br /> ❑ SEEPAGEPITS NUMBER .WIDTH R DEPTH It <br /> DMTANcs TONEAREST WELLit FOUNDATION R PROPERTY LINE It <br /> • I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND 7NE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTYORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI �,QHOOR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9514691 /o <br /> SIGNED ` TITLE r-OLCUL-l-' NT DATE <br /> xSoWb 211471' <br /> • D I NVW1171W <br /> 01 z RN a m /e� ami <br /> P. l� <br /> Rq M NT <br /> ZIP <br /> •A PJPAYe1Z .4a.W ffiM'S1'E MOSS' ti <br /> ti 9 Y G O�ga 5 O 8 <br /> ° 8 > Z <br /> s i 9 <br /> 2016 <br /> m OA <br /> mvia;t/�� V/ROMECO(//y�Y <br /> I E ?�� .fI/� `" OPPA��Nr <br /> SWM'OIE P30e.N <br /> INV <br /> DEPARTMENTU ON Y <br /> Appl1ea60n Accepted By Dated Area 1 I -I N Employee I� <br /> Final Inspection By Date TT LI SPE—CIAALL P_EERRMMIT-App.edby <br /> Chancier of Soil to Depth o13 FCPIUSump Soil ChanCter: ���''''''''' "" <br /> COMMENTS YYL� 'Z" 2_D�Pny� _AAA;Mcy� <br /> PE5C Recived Chec Amount Pe III <br /> Cede INFO Remitted Data Serviee Re asst# Invoice# Permklp# <br /> `r' 6 <br /> M-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1aaDT <br />