Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT M4 E WEBER AVE-3"FL-STOCKFON CA 95202- (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1/YEAR FROM DATE ISSUED <br /> J08 ADDRESS S I / .,fir{ !262q/NGn <br /> /� CITY/ZIP -kms f6-7[l <br /> CROSSSTREET �7 Itll�CV%PN G&.2— -�4C- �-a� PARCELSIZE A� {{{�, e <br /> OWNER NAME (�e[laGONE <br /> )� <br /> PIII <br /> OWNER ADDRESS _Jl�S/ /��. ThC "r}y I }� h CITY/STATE/LIP <br /> CONTRACTOR b�g1-�JiS C'63N S~�'�r� �-t,AfL<<Q-. 1 PHONE <br /> CONTRACTOR ADDRESS SA CITYISTATE/ZIP <br /> LICENSE C)C-42 5'C-36 OTHER 121 , r-Q[2 {'.�3LNUMDER EXPIRATION DATE &)JA 1 1 n <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICALINPORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION H <br /> TYPE OF WORK: > NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE, <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER_ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTICTANK TYPF,/MFGJQIb :[C 711x-F 1F CAPACITY 19- 0 U 901 YOFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACrrY 931 fl OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION _ R PROPERTY LINE fl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> KLEACH LINES ❑ LEACHING CHAMBERS #Or•LINES _ LENGTH OF LINES L-1 I) ft <br /> DISTANCE TO NEAREST WELL_ I`FG ft FOUNDATION _fl PROPERTYLINE ti <br /> ❑ FILTER BED WIDTH[ R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL Q FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH_ fE LENOTH ft DEPTH tT <br /> DISTANCE TO NEAREST WELL_ R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _R FOUNDATION_ ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH fl DEPTH R <br /> DISTANCE TO NEAREST WELL fl FOUNDAT!ON ft PROPERTY LINE ft <br /> SEEPAGE PITS�Z ""' =z ry flLENGTH <br /> / - // fl DEPTHI .zs tl <br /> DISTANCE TO NEAREST WELL /'{FO ft FOUNDATION ft PROPERTY LINE ft <br /> (HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK.WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQCIN COUNTY. <br /> MINIMUM 2111 URADVA'CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED-d= ly TITLE_UZ 1 4 1 IV /S k% DATE —16,-C) <br /> T-- <br /> o� <br /> Z­E 7" <br /> 1,5 0 <br /> I I � <br /> � � o <br /> 2 C m C" X, <br /> l ry` X <br /> 'a IOgr <br /> C(O o f Al I ,: p 1J Eli <br /> m O I. <br /> I IDX 3 <br /> t Ifla h O <br /> n°° N AS C <br /> .0 b9 <br /> �m <br /> mX <br /> n vi <br /> L I I I I <br /> J�• <br /> _ DEPARTMENT USE ONLS' �� <br /> Application AcceEv, <br /> B- -� � Date / )to Chi Arca 2[Z Employee[Dft S3�(C' <br /> Final Inspection Date_ /U/ ❑ SPECIAL PERA1iT-Approved y <br /> Character Of Soila th 3 FI: Pit/SU , J- <br /> P nip Soil Character: w <br /> COMMENTS 0(c( 1D� ol'.ec P '—X32c 7S 2 bd­ ht.:b,L - <br /> PE SC Recelvcd Beck#/ Amount -7 M- <br /> 31-1- <br /> rmit <br /> Code [NFD B s Remitted Date !!I-11-ic. <br /> pq/ <br /> R ucs <br /> AFz.i) lel `0((01 111b,10 <br /> 42-01-001 <br /> IMV02 ONSITE WASTEWATER PERMIT <br />