Laserfiche WebLink
QNSITE WASTEWATER TREATMENT SY STIEMEET PERMIo600 CA95202-(20$)468.3426 <br /> SAM JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT EXPIRES YEAR FROM DATE ISSUED <br /> NON-REFUNDABLE PERMIT CALL 209 53-7697 FOR INSPECTIONS ZI <br /> CITYIZIP <br /> Q7 <br /> JOB ADDRESS 20 1} PARCEL S <br /> APN ¢E �. d <br /> CROSS STREET � 2 <br /> 7 S3 PHONE <br /> OWNER NAME � n <br /> I <br /> s, �a CITYISTATEIZIP <br /> OWNER ADDRESS <br /> t f PHONE <br /> CONTRACTOR G ! ^` <br /> I CITYISTATElZIP <br /> - CONTRACTOR ADDRESS <br /> LICENSE 4C-42 OC-36 OTHER <br /> NUMBER EXPIRATION DATE <br />� Y <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> BUILDING PERMIT# 0 0 LAND USE APPLICATION# <br /> ❑ PERC TEST # ❑ ENGINEER DESIGNED!ALTERNATIVE <br /> TYPE OF WORK: ❑ NEW ITISTALLATION <br /> REPAIRIADDITipN <br /> -=ire+REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> [INSTA�LLATION. WILL SERVE NUMBER OF EMPLOYEES: <br /> R OF LIVING UNiNUMBER OF BEDROOMS: <br /> / (� CAPACITY D gal #OF COMPAR7MEiVTS 2 <br /> 1q1< SEP � YPEIMFG_�AQ��--`� <br /> ♦ CAPACITY gal #OF COMPARTMENTS <br /> O 'GREASE TRA TYPEIMFG p {t <br /> DISTANCE TO NEAREST: WELL ISO ft FOUNDATION ft PROPERTY LINE ! <br /> O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(EN LO D SYSTEM)l <br /> #OF LINES LENGTH OF LINES <br /> b0 ft.. <br /> ll LEACH LINES ❑ LEACHING CHAMBERS ft <br /> DISTANCE To NEAREST WL �ft F <br /> ELOUNDATION ft PROPERTY LINE <br /> ft LENGTH ft DEPTH ft <br /> I] FILTER BED WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ft LENGTH ft DEPTH ft <br /> 0 MOUNDED WIDTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE <br /> It LENGTH ft DEPTH ft <br /> O SUMPS WIDTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ft <br /> I] DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE Tp NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> l I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WIWBE DONE IN A DANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> IIII STATE LAWS AND RULES AND REGULAT ONS OF S COUNTY. <br /> MIN{ UM 24 HOUR ADVANCE NOTIQfi REQU p CTIONS -PLEASE CALL(209)953.7697 <br /> SIGNED i T _ o f DATE Z 'I4 - /0 <br /> h <br /> 1 <br /> t <br /> Y <br /> i <br /> E SA N A ACEL INC U <br /> I HE ALT I 6 A ME IT <br /> r <br /> (op. <br /> ' 411A <br /> j <br /> EPRTNIENT US ONLYApplication AcceptB Date ° Area Employee ID# <br /> Final Inspection ByDate 6 0 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil topth of 3 Ft: PIUSump Soil Character: <br /> COMMENTS <br /> k <br /> i <br /> PE SC Received 111l Amount Date Permit! Invoice# Permit Ill <br /> k Code INFO B Cash Remitted Service Re uest# r <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 6126I09 <br /> a <br />