Laserfiche WebLink
61`1 E WASTLWA I LK IKLI A I IVMIv It"7 a cilia a a:a.,vaa A <br /> SAN JUAQUIN COUISTI**,.wRONh1ENTAL HEALTH DEPARTMENT } <br /> 30,mopk�.BER AVE-3"'FL-ST'oC1CroN CA 95202 -(209)448-3420 <br /> NON-REFUNDABLE PERMIT &LL(209)95.1-7697 FOR INSPECTIONS EXPIRES l YEAR FROM DATE ISSUED � <br /> CITY1'LIP <br /> A L �/� M <br /> JOB ADDRESS ` <br /> D <br /> }L51E <br /> APN a PAR( <br /> CROSS STREET W0� LL� <br /> 1 l p <br /> v <br /> M <br /> OWNER NAME loe- ' , � PHONE <br /> �`I`i 1 t� SooAt, M cn n�'e[t. 6 CITYISTATEIZIP MI:11 C A q 53 t O <br /> OWNER ADDRESS <br /> PHONE Rol <br /> l-�w- 385 '-1 <br /> COm'xACTOH �J,}" <br /> CITYISTA'rE1zlPS �u-ion. GA 95aoS lJ_ <br /> CONTRACTOR ADDRESS IVW <br /> LICENSE `W- <br /> 42 ❑C-36 OTHER NUh12EH `00 5k EXPIRATION DATE <br /> Y <br /> WATER TABLE DEPTIL• ft CEOGRAPIUCALINFORMATION: Coordintles X Lp <br /> LJ PERC TEST(S) NUMUER LAND USE APPLICATION ti O <br /> TYPE OF WORK: ❑ NEW'INSTALLATION sf REPAIR� FI91� ❑ ENGIN F.ER DF:SIGNF:U lA1.T6 RNATIV}: <br /> ❑ DESIHULTIUN <br /> ❑ REPLACEMENT JJ{[" <br /> k� ❑ <br /> INStNUMBf'.R0FLIvINGUNL1T_s--I1-- <br /> ATION WILL SERVE: La RFSIIIENCF: CpA1 M11F:HCIAt. El O'I'11};H <br /> 77 <br /> r NUMDEROF BEDROOMS: <br /> SEPTIC TANK TYPFIMFG �l/YG NGnID}:H O}'EnkP1,LIYI.};S: Y <br /> CAPACITY 1-�'-+'--� gal #DI:COMPARTMENTS <br /> � � <br /> '�. '� <br /> CAPACITY gal 9 OF COMPARTMENTS CP <br /> Ll CREASE TRAP TYPEIMFG <br /> ❑ PKC TX PLANT DISTANC£TO NEAREST: WELL <br /> It FOUNDATION R PROPERTY LINE li X <br /> ❑ LIFT STATION SIZE �tlyTY�CPE OF PUMP ❑ S'}ANf)tOIL SEP RATOR(ENCI.(4sED SYsrenf) <br /> �N U OF LINES J 4 LENGTH OF LINES N _ti <br /> LEACH LINES ❑ LEAC INC HAMHEHS <br /> fl FOUNDATION 11 PROPERTY LINE f, <br /> DISTANCE TO NEAREST WELL li <br /> R LENGTH it DEPTH <br /> ❑ FILTER BED WIDTH I) <br /> 1`1 PROPCRTY LINE <br /> DISTANCE TO NEAREST WELL R FOUNDATION <br /> R DEPTH <br /> ❑ MOUNDED WIDTH ft LENGTH <br /> R <br /> R FOUNDATION R PROPERTY LINE R <br /> DISTANCE'1'O NEARES'L' WELL R <br /> ❑ SUMPS WLDTII R LENGTH R DEPTH <br /> DISTANCE:TO NEAR};ST WELI, <br /> fI FOUNDATiON ti PROPERTY LINE ti <br /> ft LENGTH Il DEPTH_ ti <br /> ❑ DISPOSAL PONDS WIDTH ft <br /> DISTANCE TO NEAREST WELL R FOl1NDATlON IS PROPERTY LINE <br /> R <br /> ❑ R LENGTH R DEPTH SEEPAGE PITS WIDTH I•, <br /> DISTANCF.'f0 NEAREST WELL fl FOUNDATION <br /> R PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PRLPARED TITS APP <br /> LICA11ON AND <br /> ANO RULES AND RECO K WILL <br /> ODSANON F,INA CCO C(lU CE WITH SAN JOAQU IN COUNTS'ORDI NANCF S• <br /> Af,JNIM 1 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECT'ION{S� PLEASE CAI.I.(2119)953-7697 <br /> `G/� TITLE C+'k'S "'OT /I P r DATE <br /> SIGNED <br /> 1 t <br /> ti <br /> ,al 1 <br /> fl 1 <br /> I n <br /> f <br /> l �} <br /> ll liv. U 11', <br /> did In I: 44, <br /> DEPARTME Sr //,/�! 1� <br /> Applicu6011 Accepted By <br /> 0 SPE 'L\}.PERMIT-Appmvcd by <br /> Final Inspection By — - <br /> Character Of Soil H OD.,oT 3 Fc P�' ' <br /> .amp Suil Character: <br /> 41 44f <br /> COMMENTS ! ,�-�`- � <br /> r S l�F'f�LiuE r (= EuJ q- <br /> "2) <br /> - <br /> tDFESC u � <br /> Permit! Invoice U Permit IDU <br /> Received CAmount ate Service RV uesl U <br /> Code INFO By Cash ash Remitted <br /> ONSL'fL WASTEWAI'CR PERMIT <br /> 42-01-DDT <br /> 128102 <br />