Laserfiche WebLink
PERC TEST # BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />CAPACITY (1i0 <br />gal <br />CAPACITY gal <br />ft <br /># OF COMPARTMENTS 2- <br /># OF COMPARTMENTS <br />PROPERTY LINE 5- ft <br />16 SEPTIC TANK <br /> <br />TYRE/MFG <br />GREASE TRAP <br /> <br />TYPE/MFG <br />? N L <br />DISTANCE TO NEAREST: WELL ft FOUNDATION 10 <br />ME EALTH DEPART <br />tJ <br />It <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STock-roN CA 95205 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />461 01/1 CITY/ZIP AC-,-( ST5 7i <br />APN g01 0 3 °3 3 PARCEL SIZE <br />PHONE <br />JOB ADDRESS C S Cirri ao s CU . 3 <br />CROSS STREET Eve r e <br />OWNER NAME :.)C c j I -caci ct STHOUV OWNER ADDRESS cC..-) I k._:d/V1(2-.- <br />CONTRACTOR 501/4 sPr,'-z, Coritt -()(‘-‘ (-)1 <br />PIO n4( ei{ eA. ?S3 () <br />PHONE '2e) (101 /7 25 <br />CITY/STATE/ZIP <br />CONTRACTOR ADDRESS <br /> pasok j„, <br />CITY/STATE/ZIP 77/046 , 91 5 s (I <br />LICENSE rinC-42 E Ll C-36 OTHER NUMBER 511(1 2'5- EXPIRATION DATE <br />WATER TABLE DEPTH: )e55 111411 JO <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: NEW INSTALLATION <br />'X REPLACEMENT 1-4-1 I k REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />X DESTRUCTION 1.1111 < <br /> <br />INSTALLATION WILL SERVE: 0 RESIDENCE COMMERCIAL <br />OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />LIFT STATION <br /> <br />SIZE TYPE OF PUMP <br /> <br />PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br />DISPOSAL POND <br />SEEPAGE PITS <br /> # OF LINES LENGTH OF LINES <br /> <br />ft <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE f <br />LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />WIDTH <br /> <br />ft LENGTH <br />DISTANCE TO NEAREST WELL <br />S WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />NUMBER WIDTH <br />DISTANCE TO NEAREST WELL <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUIRIAMEINT <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIM /51,10UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) NretfilVED <br />SIGNED TITLE DATE MAY 2 5 202 <br />TV <br />r- <br />SAN JOAQ IN UN <br />EN-Al <br />CO <br />EN VI 1M F20 <br />DEPARTMENT US/ ONLY <br />Area &-lqg Application Accepted By Date C al Employee ID# <br />Final Inspection By Date113t C SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Su p Soil Character: <br />COMMENTS Filute tE 1-6;ylk <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />LidO 41 )1 S— AY /1 47 $° g*. 21 Sa 00/3Thi.0 0 <br />42-01 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18