Laserfiche WebLink
■■■-08-27 11:44 AM (PDT) To: +1 209-464-0138 From: +1 209-869-3877 Page 1 <br /> ■�, , ,�,AN JDAGL!IN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> '1868 East Hazelton Avenue-STOCKTON GA.'Jb•LUb•bLJ1-(ZVy.I'�ooro•ttu <br /> ■� IVB N REFUNDABLE PERMIT <br /> i+.�{,.�-e;>,;1 i�•?i 3 r'•f inti::=:i`=1 i._ EXPIRES 1 YEAR FROM DATE ISSUE_D <br /> ■ , Joa ADDRESS, CITYIZIP1 �1't fl <br /> ■ � �} Lr.(�u��C / PARCELS ./.■� D <br /> CROSS STREET't4- ` — `" p . APN <br /> (7PHONE `M <br /> OmmR.NAME j <br /> OWNERADOKWi CITYISTATEJZiP _........ t <br /> 44.• + 1 <br /> CONTRACTOR ^ CITYISTATEIZ <br /> CACONTRACTOR ADDRESS <br /> , F\ \ � IPnk= C �S <br /> LIt:EN31 ,:C•4? C•36 OTHER— <br /> l f NUMSER3AL EXPIRATION DATE_ <br /> WAT£RTABLE DEPTH: V R GEOGRAPHICALINFORMATiOM- Coordifietes X y <br /> ( PEF(G TEST #— BUILDING PERMIT _LAND use APPLICATIONX <br /> — IENGNEER DEsirtiED(ALTERNATIVE. <br /> TYPE OF WORK: .. NEIN INSTALLATION y. REPAIR/ADDITIDN <br /> - <br /> REPI.AcEMENT DEs?RVcnaN _— <br /> INSTALLATION WILL SERVFRESIDENCE COMMERCIAL QTHER <br /> NIfiRBER Uf LIVJNO-UNI?3: NUMBER OF BEDROOMS: �_ NUMBER OF EMPLOYEES: <br /> 111 _❑ SEPTIC TANK TwE,TdFG CArAurf got R OF CCk1DART?AFN'r_:, <br /> -❑ GREASE TRAP TrPF!MFc, .._—.-. CAPACITY g&, iJOF CQ;.IPARTMEN79• <br /> { <br /> DISTANCE TO NEAREST: tticLL n FCUNDATIG(•J,_- fl PrtOPE.RTY LINEc <br /> ❑ L1FTS7ATION• SITE TYPE OF PUMP __❑ PKti'XPLANT ❑ SAND OiL SePARATOR(EN..rLOSED SYSTEM) E <br /> ...................................... ...................................... ................... ............... <br /> R or LIN_s 1 LENGTH OF LINES_—Lit ED—'ft <br /> 1 LEACH LINES LEACHING GHAMBER5 , j ( q f�rR , <br /> DISTANCE TO NEAREST WELL . ft FOUNDATION_ —ft' PROPERVUNE. `T <br /> (3 FILTER BED WIDTH It LENGT 4—._ ft DEPTH ft <br /> DISTANCE To NEAREST WELL it FOUNDATION_ ft PRO°ERTYLINE_ <br /> DEPTH <br /> ❑ MOUNDED WID:H _II LENGTH <br /> n a <br /> DISTANCRTO NEAREST WELL _It. FOU)NDTTICN ft PRO,?ERTY I/;IdE�-, ft j <br /> I$, SUMPS, WIDTH It LENGrIi„— r ca'�__ fl DEPTH—_,._. ,�l� <br /> 74 r <br /> DISTANCE To NGARE67 v,Eu �.`�.,}��i Et. FOUNDATION--__,._�$}.i�_ft PROPERTY LINE-�'i,�•`— ft <br /> . ft LENGTH_ <br /> It DEPTH—,._—__._ R <br /> [3 DISPOSAL PONDS WIDTH... — ft <br /> DISTANCE TO NEAkt;a I WEtl H FOUNbdTION___ It FRGPERTY LINE <br /> [3SEEPAGE PITS NDIAOER. WIDTH, tl DEPTH <br /> DISTANCE TO NEAREST WELL— It ,FOUNDATION PROPERTY LINE <br /> i HERFAY CERTIFY THAT 1 HAVk PREPARED TMS APPLICATION ANU.THE WORT(WILL BE tTONE IN ACGORD'ANCE WITH SAJOAOUIN COUNTY ORDINANCES, <br /> 6TATE LAWS Atp RULES ANU gFGULATiONS OF SAN JOAOJIN COUNTY. <br /> t t <br /> ?? <br /> �.:�:H.t Z t• �.. $;�T� �0 �cJ l 0 Fid\ h �.TV � o �k f? _�f, 0n.1 <br /> ( r� \ 77, <br /> UA <br /> TJTLE � , � •.`,: DATE <br /> SIGNED_ J : <br /> 1 `\ _ <br /> - <br /> I <br /> i <br /> VED <br /> AUG 2 201$ <br /> 1 <br /> 1 E — ERM�SNT HEALN <br /> 1— _ �RiCES <br /> Application Accepted By. Date_ Area Employoe,iDI� <br /> Final tnspocttop B.y Date _ SP. AL PER IT-Approved by <br /> Character of Soil to pe th of 3 Ft: Piti8urnp Soil Charact <br /> COMMENT <br /> PE^-3C Received ChechiB ArhoutAt Unto Ferm1G Invoice PorrnitIT* <br /> Code INFO Cash FPmtttpd ivice Re est# <br /> -- V LSOL ........ <br /> —_ <br /> L2..pj <br /> ONSITE AASTEWATER TFTMNT SYSTEJA f ERMIT <br /> ;0 4iC7 <br /> Received Time Aug- 27. 2018 11 :45AM No, 4043 <br />