Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 300E WEBER AVE-3"FL-STOCNTON CA 95202-(309)168-3030 <br /> NON-REPUNDABLE PERMIT ,,e�SCALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JORADDREES `SSS/ 64rkrANSaw/ J904r, CMIZIP Loo- v, <br /> /� 2n <br /> CROSSSTREET 'l12(0 <br /> ACe TO„f ANN 3-270-Lf - PARCELSDE 6-5- p <br /> f` 0 <br /> OWNER NAME n I,PM2D YLT4 PHONE <br /> OWNER ADDRESS CMISFATVZIP <br /> CONTRACTOR PHONE - SOD <br /> COHTMCTORADDRESS CRYISTATF/ZIP <br /> LICENSE C42 3C-36 OTHER NUMBER O ExPIRATiONDATE <br /> WATER TABLE DEPTH: A GEOCMPHICALINFORMATION: CMIM11nata % Y <br /> ❑ PERCTEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPEOFWORK: ❑ NCWINSTALLATION REPAIRIARDTDON ❑ ENCINEERDESICNED/ALTERNATIVE <br /> O REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: 0 RESIDENCE 13 COMMERCIAL ❑ OTHER <br /> 1, EROP L, PITS: I j NUMBEROPBEDROOMS: NUMeEROFEMPLOYEES! <br /> SEPTICTANII F'PE/MFG LeM� /rlCAPACITY /400 gal #OFCOMPARTMENTS� <br /> ❑ GREASE TRAP TYPEJMM CAPACITY BRI #OFCOMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEAREST: WELL /AO R FOUNDATION 7 J H PROPERTY LINE /O� fl <br /> ❑ LIFT STATION SIZE TYPEOFPUmP .s1/��� ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LILEACH LINES X LEACHING CHAMBERS r1L/r i^TTF�� #OF LINES / LENGTH OF LINES eIO J R <br /> DISTANCETONEAREST WELL 1':349 ft FOUNDATION /-.c PROPERTY LME 3S P R �1 <br /> ❑ FILTERBED WIDTH ft LENGTH R DEPTH ft ' <br /> DISTANCE TO NEARTBT WELLR FOUNDATION ft PROPERTY LINE A m <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH fl <br /> DISTANCETONGREQ WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCETONGREEr WELL It FOUNDATION 0 PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH\ ft DEPTH ft <br /> DISTANCETONGRESr WELL ft FOUNDATION R PROPERTY LINE ft <br /> RI SEEPAGE PITS NUMBER / WIDTH 3 0 DEPTH -ft <br /> DISTANCETONEANEST WELL /95' ft FOUNDATION LOI R PROPERTYLINE 30e ft hi <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCE$STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM N HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ��� TITLE /� DATE "311?T/0/ - <br /> UItL <br /> P <br /> J , <br /> D <br /> DEPARTMENT UI ONI.Y r <br /> AppiII Accep DRU -14;t-30(0 Ara Employee ID# <br /> FInvl lmpetioo By t oMID 13 SPECIAL PERMIT-Approved by <br /> Chvaeter of Sail t9@pf3 FI: PIUSUMP Soil Chvneter. <br /> COMMENTS Aj FAj A-A a A-, „Q/J �PH-76- NJ <br /> i <br /> PE Sc ReeeivM AmomT Dote PermiU IvwRe# Permlt lD# <br /> Cole INTO B CMh Rawn-M, SerYIp. uMp <br /> y2-IO its t , 6 a3Q.B1) <br /> 0342-OH ONSITE WASTEWATER PERMIT <br /> IMMODJ <br />