Laserfiche WebLink
ONSITE WAST-`NATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH Iaft MEAT 300E WEBER AVE-3"FL ` <br /> -SFOCKT '95202-(209)068-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDPE3E �i �i . r I ^ ,J ,/ - CITY/ZIP I1J_n. <br /> ne <br /> CROMSTRUT F K , % APN L Ff '2 L 0 'I � PARCELSIZIE 12�, SSa/ p <br /> T O <br /> .� OWNER NAME 'F/ A:y- +' =11�• 1 L/LS PHONE <br /> V 1 \ <br /> 1) -1[ 1 ? �{ CITV/STAT"IP r Iv`�C' y T}-O / k <br /> OWNERADDRESS <br /> CONTRACTOR PHONE ` _1S ` <br /> CONTMCTORADDRBS4 CITY/STATUZIP <br /> LICENSE ❑C42 0C-36 OTHER NUMBER E%PI RATION DATE <br /> WATER TABLE DEPTH: fl GEOGRAPHICALINPORMATION: Caordiroom X V <br /> PERC riUILDINGPERMrr# LAND USE APPLICATION III '3 N <br /> TWE OF WE ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OPLIVINO UNM; NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPF/MFG CAPACITY Bal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY gal It OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEAUGHr: WELL R FOUNDATION R PROPERTY LME R <br /> ❑ LIFT STATION SIZE TYPEOFPUMP O SAND OIL.SEPARATOR(ENcLoSEDSYsTEAD `1J <br /> L) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS It OF LINES LENGTH OF LNES fl O <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl T <br /> _ ❑ FILTER BED WImN P LENGTH fl DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl <br /> ❑ MOUNDED talon" RT LENGTH R DEPTH fl <br /> DIWANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH u�a^' R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LIFE fl �I <br /> ❑ DISPOSAL PONDS WIDTH F R LENGTH fl DEPTH fl \ <br /> DHTANCETO,NEANEST WELL A FOUNDATION R PROPERTY LIFE fl <br /> ❑ SEEPAGE PITS NUMBER W.M ` ..A D - ft DEPTH fl <br /> DISTANCETONEAREST WELL R F.!ATIOR- R PROPERTY LINE 'V R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCESPSTATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY.,`__ <br /> MINIMUM 34 OUR ADVANCE NOTICE REQUIREDFOR INSPECTIONS-PLEASE CALL(209)953-76911 <br /> SIGNED �_._ _. TITER /� _ �.L DATE <br /> - ------ --------- -- r, <br /> by- ty c e @(nlosoccX;:i es.°axxs <br /> II�I OA5 �P g� i�6 C�C <br /> R M.a <br /> (n) �Lo <br /> �.',.. .65 L0 ..,IyJ P <br /> AA <br /> D: C Pns� <br /> Q® <br /> g4 wm �Y <br /> _ iii aM C: <br /> FFF <br /> •I ��e d� Sp i \ 1 <br /> I Ilia �— G <br /> Fh m <br /> -_. .—` DEPARTMENT ISE ONLY i <br /> Application Accepted By S/-fk.` Date A. 1 En@IOyee IDPi 4�CTr, <br /> Final lnrpection By Data ❑ SPECIAL PERMIT-AppmvWby <br /> Character of Sall to Depth M73 III: PiUSump Soil Character: <br /> COMMENTS <br /> PE SC Received Ch. Amount Permit/ <br /> ann Code TSC M1 Remitted D°m Service uertp Invoke Permit IDp. <br /> 1 <br /> <3L3-001 ONSITE WAS4EWATER PERMIT <br /> y I}lJYL00J <br /> FBI <br />