Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNFY ENVIRONMENTAL HEALTH DEPARTMENT 361E WEBER AVE•3"FL-STOCXTON CA 93202 •(209)068-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FR M DATE ISSUED <br /> JOBADDRESS 6/D O Se a H C CITV/ZIP -4 0'" 1 $1 O S21 <br /> • CRMSTREET APN �$ /—d7 G�1' 71 O M <br /> ' PARCEL BIZE Q O <br /> 7 OWNER NAME O H'f Oras C// PHONE + <br /> OWNERADDRESS //pp CITYISTATIJZIP <br /> CONTRACTOR PMOnE <br /> CONTMCTOR ADDRESS r C�/�P(f1Z I�- I� �(CCITYIBTAATTE//21P �+4 <br /> LICENSE 13C-42 13C-36 OTHER •1 NUMBER •J 7 p }P' EXPIRATION DATE 6+J Q g <br /> WATERTABLL DEPTH: fl CEOCRAPHICAL INFORMATION: Cooldisat. X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION H ( /T <br /> TYPE OF WORK: 19 New INSTALLATION ❑ REPAIWADDJT30N ❑ ENCINEERDESIGNED/ALTERNATIVE V 1 <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIOENCE C3 COMMERCIAL <br /> a� 13OWNER " I <br /> NUMB ER OF LIVINCUNI11: 'p NUMBERGFBEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPF/MFO 7 -�D-efN ! CAPACITY / OZ <br /> gel 40PCOMPARTMENTS <br /> ❑ CREASETRAP TYPIVMFG CAPACITY Sal HOFCOMPA¢TMENTS <br /> ❑ PKG TX PLANT DISUANCETONEAREST: WELL R FOUNDATION 7 ft PROPFATY LINE KaG Ij <br /> ❑ LIFT STATION E�AASize TYPEOFPUMP //LL /�Oa O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES p LLACHINC CHAMBERS COO ra`f HOF LINES LENGTH OF LINES ���ff0 R <br /> DIbTANCETONEAREST WELL 00 ft FOUNDATION /0 fl PROPERTYLHHI �T�O Fl <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH ft <br /> DISTANCETONEAKEST WELL ft FOUNDATION It PROPERTY LINE Fl <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WI-N IS LENGTH ft DEPTH fl <br /> DISTANCETONEANJSr WELL R FOUNDATION ft PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH R <br /> DISTANCET04EAARF9V WELL R FOUNDATION R PROPERTY E R <br /> ❑ SEEPAGE PITS WunNi T/ R LENGTH fl DEPTH <br /> • DISTANCETONIDUUM WELL It I.-DATION O ft PROPERTY LINE fY R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION <br /> AN AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM'UUMU HOUI 1) Y I EREQUIRED FOR INSPEECTIONS PLEASE ICIL.(209)953-7697 <br /> S <br /> SIGNED A.LH++bU�IJ U TITLE S•-ON M(,eQION DATE <br /> f <br /> I <br /> N <br /> S tH <br /> DEPARTME U O. Y pp <br /> Appllwipa Ae ,NNI By le U Area employee IDg0_ <br /> PRO laspwioa Ry D.J. ❑ SPECIAL PERMIT-Approved by <br /> Chancier of Soil to Dept,00 FU PIUS➢mp BOD ChArIli <br /> COMMENTS VQ.W /a, T TJ-.D(JS <br /> • /r <br /> PE SIC Receivspv Amount Dam PermiU Invoke8 PorMtlDq <br /> Code INFO B Calb Remised Service Re uen4 <br /> � 1 8S 0 D3 oD 3s � <br /> �I-091 <br /> IL2p2 ONSITE WASTEWATER PERMIT <br /> .Y <br />