Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIp CA 95202 - (2091469-3426 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> CALL(249)953-7697�``FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> NON-REFUNDABLE PERMIT <br /> tx CITYIZIP <br /> Jon ADDRESS �Z Rf —L6015 <br /> ' <br /> PARCEL SIZE <br /> APN <br /> CROSS STREET <br /> O t <br /> PHONE v <br /> OWNER NAME <br /> OHTIER ADDRESS <br /> F1 <br /> CITYISTATEIZIP <br /> IE1 _ <br /> PHONE <br /> CONTRACTOR I <br /> C[TY7STATEIZIP <br /> CONTRACTOR ADDRESS <br /> NUMBER EXPIRATION DATE 1 <br /> LICENSE ❑C-42 ❑C-36 OTHER <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> PERCTE5T # BUILDING PERMIT# LAND USE APPLICATION# <br /> ❑ REPAIRIAPP7TION ❑ ENGINEER DESIGNED lALTERfaATri'E <br /> TYPE OF WORK: ❑ NEWINSTALLATION E DESTRUCTION <br /> ❑ REPLACEMENT <br /> 1N ! <br />�� 1 INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL C3 OTHER <br /> NUMBER OF LIVING UNITS: <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> F <br /> Cl SEPTIC TANK TvPElMFc CAPACITY gal #OFCOMPARTMENTS <br /> ❑ CREASE TRAP TYP£IMFO <br /> CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL <br /> R FOUNDATION ft PROPERTY LINE ft <br /> 131i�p ❑ LIFT STATION, SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> IP ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES k <br /> R PROPERTY LINE t� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION w <br /> �'^ R I <br /> f'^� ❑ FILTER BED WIDTH ft LENGTH k DEPTH <br /> DISTANCE TO NEAREST WELL R <br /> 1pi# FOUNDATION ft PROPER YY LINE R <br /> ❑ MOUNDED WIDTH <br /> k LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH fl DEPTH R <br /> " 1 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> LlDISPOSAL PONDS WIDTH ft LENGTH _ R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> (�; <br /> L) SEEPAGE PITS, NUMBe.R <br /> WIDTH ft DEPTH tl <br /> 1 DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE k <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS <br /> STATE LAWS ANDION ANDTHE RU ES AND REGULATIONS OF SANEIN JOAQ IOWITH SAN dOAQU]N COUNTY <br /> N COUN FY <br /> 0. <br /> ?MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)953-7697 <br /> 1 - TITLE S v �- - DATE <br /> S SIGNED <br /> r ` <br /> i e _ <br /> �1 S <br /> i A <br /> R <br /> t Q Q r <br /> — 14 M r <br /> DEPARTMENT U ONLY 2 F- <br /> M Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved hY <br /> f—f,' <br /> Character of SoH to Depth of 3 Ft: PitlSump Soil Character: <br /> COMMENTS <br /> F! <br /> I PE SC Received C Amount Date Permitl Invoice# Permil IDN <br /> Code INFO B Cash Remitted Service Re nest# <br /> 57 <br /> k ONSITEWASTEWATER PERMIT <br /> 42-6�-0111 <br /> 12222663 <br />