Laserfiche WebLink
ONSITE "WASTEWATER TREATMENT SYSTEM"FRMIT <br /> • 0'� SAN JOAQUIN COUNTY ENVIRGNMENTA TN DEPARTMENT 600 E.Mein Street-$ INCA 95202- (209)468-3420 <br /> NON-REFUNDABLE PERMIT (.':N 1.T(209)953-7697 POIt I io v, EX. RES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS a� 12>2 CITY/ZIPeP pl�J5 3,77 7 <br /> CROSS STREET `l�i� APN O+_ L4'I PARCEL SIZE ( 17 <br /> 15 . 2— <br /> a <br /> Sr �s b <br /> OWNER NAME r�.�j PL��,(Se�`> b ( d lM a PHPH�O,NE/I►� �{ / y <br /> OWNER ADDRESS �'�� v�47� \� �/yi rep—, CITY/STAT"IP \• <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS . CJ CITV/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTIIER NUMBER EXPIRATION DATE / <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X 3• Y'(2(o2'8 <br /> L3 PERC TEST N BUILDING PERMIT# LAND USE APPLICATION#MS <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER b <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: N <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COW'ARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYRE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LIMB LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH it DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH fi DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION III PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPT[I ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION B PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I 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 /> 41 <br /> �' ,( NIA1AtU 11(Jll2:ADY'W('ENOI'KERFQUIRF'A F0121NSPECIIONS-PI1'\Sl:(-,ALL('u��l•I- it,-eE <br /> SIGNEN=—-�(��v_.S� �, /4.Ol/ Q TITLE 7c• t �L t ATE <br /> D <br /> 13 <br /> dr <br /> 7 <br /> NY <br /> N L <br /> ENT <br /> Application Accepte ate Area Employee ID# <br /> Final Inspection By ale ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep of 3 Ft: P'/Sump Soil Character: <br /> COM NTS <br /> PE SC Received Chec Amount Dale Permit/ Invoice# Permit IDN <br /> Code INFO By Cash Remitted Service Request# <br /> 42-02-001 web ONSITE WASTEWATER PERMIT <br /> 12/2212003 <br />