Laserfiche WebLink
ONSITE WASTEWATEN�-'`nrt ,ATMEN-I' SYSTEM PERMIT <br /> /�N.IOAQUIN COUNTY FNVIRONMENT Ati HE.AI:rR DEPARTMENT }� t 304 I:WER}:R AVE-3"'A.•STOC',KTON CA 9520 68-3420 .a <br /> NON-REFLNDABLE PERMIT .A f/� L CALkca L(209)95j-'7697 TOR IN'SPEC.TIONS EXPIRES I YEAR FROM PATE ISSUED <br /> Joe ADDRESS ��R - Cn'vlllr' <br /> CROSSSTREET �f�r['/ �� APN (,.f[I1�1— + '�`J PARCEL SI7.E tl <br /> k� <br /> OWNF.RNAME 1 ][ �p.+r5�. y I IIDNE .. <br /> F OWNER ADDRESS , CITVIS'TATIIZIP - <br /> f CONTRACTORQ. - PIUJN}: L L <br /> CONTRACTOR ADDRESS I C:ITYISTATEI%IF 5-2116 <br /> LICENSE ❑C-42 ❑C-36 (VIER NLmBE'.R £7(PIRATIr}N DATF. <br /> WATERTABLE DEPTH: R GEOGRAPIUCAL INFORMATION:. Coordinates X Y ti <br /> FERC TEST # BUILDING PERMIT# LAND USE A PPL I CATION#-0 -- <br /> TYPE OP WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENCEN LEN DESIGN ED lA I.TERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE: ❑ COMMLRCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBFR OF EMPLOYEES: <br /> ❑ SEPTIC TANK TVPFIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPOMFG CAI'A('I'r1' __ gal #nr(:o+tPARTMI.NTS n7 <br /> LF PKG TX PLANT DISTANCETDNEARE.9T: WELL 0 FOUNDATION R PROPERTY LINE R y <br /> ❑ LI FT STATION SIZE TYPE OF PUMP- ❑ SAND 011,SEPARATOR(ENCLOSED S1:S'TEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> R 6{(\/'rte,{,� <br /> DISTANCE TO NEAREST WELL. R FOUNDATION R PROPERTY LINE �,/ <br /> f Fly <br /> ❑ FILTER RED WIDTH R LENGTIi R DEPTH R <br /> DISTANCE.TONEARF.ST WELL R FOUNDATION R PROPERTY LINE <br /> Fl <br /> 1 ❑ MOUNDED WInTH R LENGTH R DEPTH R <br /> 11 DiSTANCETONF.ARF.ST WELL R FOUNDATION fl PROPERTY LINE Il <br /> iii ❑ SUMPS WIDTH R LENGTH 11 DEPTH R <br /> DISTANCE TO NEAREST Wr;L1_ R FOUNDATION I1 PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH 'R LFNGTII . R DEPTH R <br /> DwI'ANCETONPARF.ST WELL. R FOUNDATION 11 PROPER I LINK R <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH 11. <br />'I DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQIJ COUNTY <br /> ORDINANCES,STATE LAW'S AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> J� 1P11 IMUNI 24 HOUR ADVANCE NOTICE REQUIRED FUR INSPECTIONS!-PLEASE CALL,(209195.1-7697 7 <br /> SIGN F, JC Jul`� TITLE�t7��lN� DATE <br /> 1 <br /> y ZI <br /> `�. <br /> } <br /> { <br /> 1 <br /> N A <br /> E LH E <br /> F <br /> DEPARTMENT USE ON'-f / <br /> Application Accepted tFi1Z <br /> - Delc �I Area I.n,Fl�,yee lD# >�--Final Inspect a By max U Datc i���J ❑ SPECIAL PERMITAPrrovcd by <br /> Character of, pth o PRISump Soil Character: <br /> COMMENTS 5�2 - <br /> Lld <br /> PESCRerelved Check#1 APermitfCodc INFO B Zash ReDatc ServlceR Hest# Im'oice# Pcrmii ID# <br /> 42 02 M11 L" NSFFI 11'ASI"EWATER PERMIT <br />