Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3"FL-SEOCRTON CA"202-(209)(68-'3120 <br /> NON-REFUNDABLE PERMIT A L 209)953-7697 MR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> ^ <br /> IMS, <br /> JOB ADDRESS ' I �/'� CIT/Z P <br /> — J <br /> CROSSSTREET V' e'er`c F"'--`R '-` AM uG 7� 'T V� ' � Pw At. <br /> ` ' <br /> OWNERNAME V {-d �I 1 gq <br /> PHONE- <br /> Iowa OWNER ADDRESS I� ( yti A�•lL -ww� CITWSTATE/ZIPA'___ �r"- ` 2 Z-�o <br /> CONTRACTOR , PHONE ' <br /> CONTRACTORADDREM CEEVISTATE P <br /> ` LICENSE 0 C4 ❑C-36 CO. NUMBER E%PIRATNIN DATE <br /> WATER TABLE DEPTH: fl GEOGRAPHICALINFORMATION: CMIrdluales X Y <br /> ff PERCTEST k BUILDING PERMIT# LAND USE APPLICATION# � U <br /> TYPE OF WORK: ❑ NEW INETALWTION ❑ REPAIR/ADDITION ❑ ENGINEERIDES.GNEDIALTERSW <br /> ❑ REPLACEMENT O DFSTRUCHON VY� <br /> INS. INSTALLATION WILL SERVE: ❑ REEIDENCE El COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBEROFBEDROOMS: NUMBER OPEMELDYRE6: <br /> ❑ SEPTIC TANK TYPF/MFG CAPACITY gel 00F COMPARTMENTS <br /> ` ❑ GREASE TRAP TYPFJMFO CAPACITY gal k OF COMPARTMENTS <br /> ❑ PRG T%PLANT DISTANCE IV NEAREST: WELL ft FOUNDATION R PROPERTY LME R <br /> ❑ LIFT STATION SITE: TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENcLosm3TstEM) <br /> L ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLMES LENOIH Di loris ft <br /> DISTANCETONGREST WELL It FOUNDATION It PROPERTY LINE A <br /> ❑ FILTER BED WivOi ft LENGTH R DEETx R <br /> DmO,NCETONEAREIT WELL fl FOUNDATION R PROPERTYLME R I <br /> ❑ MOUNDED WINES R LENGTH R DEETH ft <br /> DISTAN"TONEAREST WELL It FOUNDATION fl MOPERTYLME ft <br /> ❑ SUMPS WEBER ft LENCI'H fl DEPTH fl <br /> DISTANCETONEARESI' WELL fl FOUNDATION R PROPERTY LINE R <br /> ` a ❑ DISPOSAL PONDS Wmrx R LENGTH ft DEPTH R <br /> DISEANCETONEAREST WELL It FOUNDATION ft PROPERTY LME fl <br /> ❑ SEEPAGE PITS NUMBER Wmrx It DEPTH R <br /> DISTANCETONEAREST WELL R FOLATOV ON ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAKI JOAQUIN COUNTY <br /> I. ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN CW NT V. <br /> �_1 MINIM UM,24 HOUR ADVANCE NOTICE REQUIREDFORINSPF.RIONS-PLEAS I CwLL12041953-J69p <br /> SIGNED_ _ 1 - - -R--��—� TITLE ^ \��� DATE z/ 2Lm o <br /> I _ IJ <br /> O 1 G <br /> ` i , <br /> V <br /> J <br /> I <br /> I I <br /> 1 <br /> DEPARTMENT _EON <br /> AppllnHon Amepted By �:1 1 \ �'t- Date �' "r Atm Employs ID# <br /> 6. FINN Inepalbn By Dale ❑ SPECIAL PERMIT-AWp Wby <br /> Chonmer of Soll b Depth o1`3 Fn PWSump Soil Chonn[PO <br /> COMMENTS <br /> 6. <br /> PE SC Rseived C6sid(. Amount Dae PermlV Invoke# Permit 10th <br /> Code .N.CvaII ReminM Servke R,,NJ0 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 1=003 <br />