Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SANJOAQUIN COI:NTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AYE-3"'FL-ST'OCK'rO%CA 95202 - (209)4614-3420 <br /> NON-REFUNDABLE PERMIT /CALL(209)953-7"697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS, �3FpS (/� av � LK CR'Y/LIP _ - M <br /> h <br /> s 2 5 547 D <br /> CRASS S-:BEET W!f e45. A&C 1�1 /APV �" -'3y PA RCEL SITE, We <br /> OWNERNA94E 'Q [�Dl/F S PHONE :332 <br /> OWNERADDRESS CITYISTATE/LIP <br /> CONTRACTOR _�R'S JO� .T1s(1.-7 � �- PRo%E,^-Y <br /> CONTRACTOR AODAFCS 71.t%r� C f�UCG/ 9 .oA-V CITVJSTATF.IZIP lc,al.�; <br /> LICENSE 32 ❑C-36 OTHER r NUMBER +�5'`3a y E%PIRATtON DATE <br /> W'ATTR TABI.F DEPTH: t2 GEOGRAPHIC'AL INFORMATION: Coordlostea X Y <br /> ❑ PERC TEST(S) NUMBER LAND I)SF APPLICATION# <br /> TYPE OF WORK: h;EW INSTALLATION ❑ REPAIR/ADDITION ':J ENGINEER DESIGNED/ALTERNATIVE <br /> O RLPLACEMENT Q DESTRUCTION <br /> INSTALLATION WILL SERVE: P-.RESIDENCE ❑ COMMERCIAL OTHER_ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NLMBEROF EMPLO <br /> SEPTIC TANK TYPE/MFG�tACI_} CAPACITY_fagp gal ; OFCOMPARTMEN"IS <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY gal #OFCOMPARTMEN"i'S _ <br /> Q PKG TX PLANT DISI'ANCE T'O NEAREST: WELL ft FOUNDATION f'. PROPERTY LINE Il <br /> �0 LIFT STATION SIZE TYPE OF PUMP ❑ SAND Oji.SEPARATOR(ENc LosEo SYSTEM) <br /> pi- LEACH LINES )kl LEACHING CHAMBERS - So #OF LINES LENGTH OF LINES :SIO R <br /> DISTANCE TO NEAREST WF.I.L H FOUNDATION R PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DMANCE TO NEAREST WELL_ _11 FIXJNDATION' R PROPERTY LFNF. R <br /> ❑ MOUNDED WIDTH ft LENGTH _ft DEPTH _ ft <br /> DISTANCE TO NEAREST WELL_ _._ft FOUNDATION ^T ft PROPERTY LrNF. ft <br /> ❑ SUMPS WIDTH ft LENGTH _ _ ._ ft DFPTH R <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ll DEPTH ft "J <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIXF. ft <br /> ❑ SEEPAGE PITS WIDTH 1) LENGTH ft DEFtH ft <br /> DISFANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> I 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 REGUTATiONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED _ _ T[TLE�/ DATF. <br /> U <br /> IForR <br /> N <br /> PRIES <br /> DEPARTMEN7 US ONLY / c{ <br /> Application Accep <br /> By I, Dale '.Z'�/U Arra 21 Employee ID#_O l <br /> Final Inapectian Dale �O"l ❑ SPECIAL P RMIT-App oved byCharacter o! 1 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS ; /o -r��.�.n! /( s <�+e a /COT t (C7 -e cS"f'T le, <br /> PE SC Received Che Amount Permit <br /> Code INFO By as Remitted Date Service Re uesl# Invoice# Permit IDI! <br /> ¢2-03 IL <br /> 42-01.001 <br /> 1712/02 ONSITE WASTEWATER PERMIT <br />