Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HA2E.LTON AVENUE-sTccK7oN CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALF 209 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 23485 Hansen rd CITYIZP Tracy,CA <br /> CRO58 STREET N M1L- I AP PARCEL SIZE 11 q 7 c <br /> OWNER NAME 01-1j"ll76 er I ►1 YI I i'Z� PHONE <br /> OWNER ADDRESS CITYISTATEIZIP <br /> CONTRACTOR Mikes 9ackhos Service PHONE 209-456-2865 <br /> CONTRACTOR ADDRESS P.p-Sox 650 CITYISTATEIZIP Manteca,CA 9533E <br /> LICENSE ::_C-42 r-:C•3{6'� OTHER A NUMBER 608654 EXPIRATION DATE 2020 <br /> WATER TABLE DEPTH: C+ It GEM RAPHICAL INFORMATION: Coordinates X Y <br /> D PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADOITION 7 ENGINEER DESIGNED]ALTERNATIVE <br /> 7 REPLACEMENT OUT-OF-SERVICE SEPTC SYSTEM r' DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ' COMME> AL CG OTHER <br /> NUMBER OF LIVING tI NITS: NUMBER OF t3EOROOM6: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> 0 GREASETRAP TYPE/MFG CAPACIri gal. #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE It <br /> D LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES 2 LENGTH OF LINE 19a R <br /> DISTANCE TO NEAREST WELL 100 ft FOUNDATION 30 It PROPERTY LINE <br /> Q FILTER BED WIDTH ft LENGTH h DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE R <br /> ❑ MOUNDED WIDTH It LENGTH R DEPTH ft <br /> DISTANCE To NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ sumps WIDTH ft LENGTH ft DEPTH It <br /> DISTA NCE TO N FAREST WELL ft FOUNDATION ft PROPERTYLINE R <br /> ❑ DISPOSAL PONDS WIDTH N LENGTH R DEPTH tT <br /> DISTANCE TO NEAREST WELL It FOUNDATION N PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL N FOUNDATION ft PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILD-BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> MINffly E gALL z 3- <br /> SIGNED Mike Fuller TITLE Contractor DATE J(�� U �R <br /> I� DEPARTMENT N L Y _ r <br /> Application Accepted By L` Date n 0,3 0 Area s _+ Employee ID# s k. <br /> Final inspection By Date G SPECIAL PERMIT•Approved by <br /> Character of Sail to Do of 3 Ft: PI ump Soil Character: <br /> COMMENTS PG!t v/if. t"� b o ``C'7 <br /> PE SC Received Cho Amount pate Pern'IG InVOlca# Perm It ID# <br /> Coda INFO B ash Remitted Service R.1uest# <br /> �a1L7 I!5 <br /> 42.0I ON SIT E WASTEWATER TRTMNT SYSTEM PERMIT <br /> 471411E <br />