Laserfiche WebLink
} ONSITE WA! EWATER TREATMENT SY EMPERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALih-4 PARTMENT 304 E WEBEh AVE -3'"FL-STOCICTory CA 95202 - (204}'468-3420 <br /> NON-REFUNDABLE.PERMIT ° CALL(209)953-7697 FOR INSPECTIONS EXPIRES I REAR FROMDATE`ISSUEI) <br /> JOB ADDRESS 9S- <br /> -7—RAW. <br /> y <br /> CROSS STREET ,yZ/�- y1 }� APN :0110 -0V PARCEL SIZE /J? .� p <br /> OWNER NAME _J!©L�.SC �y[� I•t 'PI�� _ �'... PHONE $ <br /> / ✓:24. 13q <br /> OWN ER ADDRESS � /-t® +5�y <br /> CITY/STATE/ZIP (� = <br /> • <br /> CONTRACTOR P7 J,Y antLY T/AI PHONE_ ELI(,3 <br /> CONTRACTOR ADDRESS CIT.YISTATE/Z[p` tv <br /> . <br /> I LICENSE ❑C-42 ❑C-136 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ^' / C? ft GeOGRAPHICAL INFORMATION?: Coordinates X y <br /> FERC TEST. 3 _ BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: a NEW INSTALLATION U REPA'IR/ADDITiON ° ."❑.",:ENGINEER DE IGNEDIALTERNATIVE <br /> ❑ `REPLACEMENT n ❑,. DESTRUCTION r; <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑'r'COMMERCIAL ❑'OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUM.BER. OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS V <br /> .. _�;.;. 'i .....J <br /> © CREASE TRAP TYPE/MFG CAPACITY gal. #OF COMPARTMENTS <br /> ❑- PKC TX PLANT. DISTANCE'TO NEAREST: ,WELL '} . ftFOUNDATION A-' 'I71PROPERTY LINE 'YI1 ft <br /> ❑ LIFT STATION SIZE r TYPE OF.PUMP ❑ SAND OIL SEPARATOR(EivcLosEo SvSTIaM) <br /> ❑ LEACH 'LINES ❑ LEACHING CHAMBERS #OFI NFs '-L'ENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION -ft � ' PROPERTY LINE $ <br /> ❑ FILTER BED WIDTH ft LENGTHft DEPTH <br /> DISTANCE TO NEARESTWELL ft FOUNDATION! - ft- PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> D SUMPS WIDTH - ft LENGTH DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 1 <br /> ❑ DISPOSAL PONDS WIDTH ft. .LENGTH 7•i 'ft;� .r DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft V <br /> _ r <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft =DEPTH 1+ a ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> - .�- - <br /> 1 HEREBY C ' IFY THAT I'HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> AOINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY.1,t ? f:tUR ADVANCE NOTICE REQUIRED F,OR,INSPECT:IONS, PLEASE.CALL.(20%)A953-7,697 <br /> SIGNED TITLE •DATE •" <br /> Te <br /> A: rf +r V <br /> T <br /> � t <br /> Z, ` 'Ad <br /> E., i,rX 13- <br /> 1 <br /> A.1 ;Yl?1ta .i <br /> h <br /> N <br /> oil <br /> ` - - <br /> g <br /> zT <br /> z. - .r,♦ 5` is `?r;? ' .* - _ _.. <br /> N <br /> - 711=7-1 L <br /> _ 1, a 1 <br /> - PARTMEON Y - <br /> r <br /> Application Accepted By NT SE Area Employee ID# � T <br /> PE <br /> Date I <br /> Final Inspection By %i- d ❑ SPECAL RMIT ,Approved by . <br /> E .:'y <br /> Character of Soil to De 1 of 3 Ft: Pit/Sump Sol]Character: <br /> COM E TS <br /> PE SC cei Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted :>f ^IaiY., Service Request# -1;4; a_ i <br /> �- 5Z 5�. y� - o ;�3.7-0 <br /> _mm <br /> _ I <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 C <br />