Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3'°FL.STDCETON CA 95202 -(2091168.7120 <br /> NON-REFUNDABLE PERMIT CALL 20(9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �Ia('13 S.n mae,+A0y RLQ CITY P <br /> CROSS STREETA/'^O'I�f-�s R.cCy APN 9 —25 =08 I I PARCEL SITE I �CZC-M <br /> OWNER NAME r u,-'CI. 1 ,/�1 PHONE X34 —5858 <br /> OWNERADDRESS IIA 12 s MGr,tr�6.Y Vs cNY/$TATvnr LRTPIrp Off//, 'T CA l�4�S33o <br /> CONTRACTOR hAncE U.f MGPt�0. PHONE` /to/ - 100(v <br /> CONIAACTORADDRESS 1110 SLrW fl �0 IS CITY/$TAl'UZIP <br /> LICENSE CI C42 (3 C-36 OTHER - NUMBER EXMMTIONDATE <br /> WATERTABLEDFJRH: /O R GEOGRAPHICAL INFORMATION: Coordinate{ X <br /> B. FERC TEST BUILDING PERMIT N LAND USE APPLIC ON N <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ NGINLER MIGNED/ALT AIV <br /> ❑ REPLACEMENT ❑ DL4TRUCTQY <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OIRER <br /> NUMBEROFLIVINOUNDS: NUMBER OF BEDROOMS: NUMBBROPEMPLOYEFS: <br /> ❑ $EPTIC TANK TYPWMFG CAPACITY Eel NOFCOMPARTMENTs <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY Tal N OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEAREFT WELL It FOUNDATION R PROPERTY UNE ft <br /> ❑ LIFT STATION SITE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> IN V <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS NOFLNES LENGTH WLNES It <br /> DISTANCE TO NEARTST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH fl LENGTH fl DEPTH It <br /> DISTANCETONEAREST WELL R FOUNDATION It PROPERTYLINE fl <br /> ❑ MOUNDED WIDTH ft LENGTH a DEPTH ft <br /> DISTANCLTONEAREA-r WELL R FOUNDATION fl PROPERTY LINE ft <br /> ❑ SUMPS WIDTH fl LENGTH ft DEPTH fl <br /> DISTANCETONEARERT WELL R FOUNDATION It PROPERTYLINE fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH B DEPTH ft <br /> DUFFANCETONEARMT WELL fl FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEJUGry WELL It FOUNDATION It PROPERTYLINE fl <br /> I HEREBY CERTI FY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Ar4f TOC BrJnN/ DATE y- /3 06 <br /> s <br /> 21/ <br /> Aw <br /> I, <br /> f <br /> 7 <br /> . / <br /> DEPARTMENT U <br /> FIRMApplInspe tion By B U Date-ge Ara Employed by (1OT=-1.ClLL� I <br /> FIRM lmptttbn By Date 06 [3 SPECIAL PERMIT-Approved by <br /> ChMaeter Ff SuII to hof 3 Pt: PI ump Soil CRmcar: <br /> COMMENTS <br /> PE SC Received Ch.Rw A.UM PefedD <br /> Code IBM 1 34 Cash Remitted DaM SereiceR uatq InroiedN PeraR IW <br />