Laserfiche WebLink
ONSITE WAST'WATER TREATMENT SYSTEM PERMI" <br /> j SAN JOAQUIN COUNn ENVIRONMENTAL HEALTH',,,,AMENT 3ME WEBER AVE-3-FL-6TOCRl 95202 -(20)A66JC20 <br /> Ir{ <br /> NON-REFUNDABLE PER MIT BALL 209 9g3- <br /> ( 7697 FOR LVSPECIION'S EXPIRES I TETR FROM DATE ISSUED <br /> Joe ADDRE59 ✓> /yq !h. �' ti e.l <br /> CRO555TREET ( � - a C 1' LT \ ppyAgCEL S a <br /> M ' <br /> OWNER NAE <br /> 1 ✓ L PHONED`* Y� <br /> OWNER ADDRESS ✓u J `. e. p�! .\ _ p <br /> fL l CTFY/$TATFIZIP ` I .� C �� _1 r "AJ� <br /> CONTRACTOR t J/T �l <br /> PNONE `A Li Y P/ <br /> 1 CONTRACTORADDRESS <br /> Ctn/SrATVZv <br /> Llcenfi¢ ❑C42 0C-36 OTHER NUMBER E)vIRAT1ON DATE <br /> WATERTABLE DEPFIV R GEOGRANHICALINFORMATION: Coordinates X - Y <br /> YIB 14 PERC TEBT p I BUILDING PERMIT# LANDUSEAPPLICATION# F <br /> TYPE OF WOR.: ❑ NEW INSTALLATION ❑ REPAIR/ADIRCON ❑ ENGINEERDFSIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> L <br /> INSTALATWILL SER : ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NVMBEROPIONVELIVING UNITS: NUMBER OP BEDROOM6: NVMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MPG CAPACTY gal NOF COMPORTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal NOFCOMPARTMENTS <br /> ❑ PEG TX PLANT DI6TANCETONEARESU WELL R FOUNDATION R PROPERTY LINE It <br /> ❑ LIFTSTATION SIZE TYPEOPPCMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYSEENO <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS NGFLmE6 LENGTH of Lw[s R <br /> DDURNCETONEAREST WELL R FOUNDATION R PROPERTY LME R <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH fl <br /> DISTANCE TO NEARES! WELL R FOUNDATION R. PROPERTY LME R <br /> ❑ MOUNDED WHER ft LENGTH R DEPTH R <br /> Dt6TANCETO NEARFSr WELL R FOUNDATION a PROPERTY LINE 11 <br /> ❑ SUMPS WmTq ft LENGTH It DEPTH It <br /> DISTANCETONEAREST WELL It FOUNDATION R PROPERTY LME R <br /> i ❑ DISPOSAL PONDS WIDTH -R LENGTH R DEPTH R <br /> DIETANCETONEAREET WELL R FOUNDATION ft PROPERTY LINE. ft <br /> ❑ SEEPAGE PITS N..ER WIDTH It - DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME R �- <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNn <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COURTS <br /> M I M M U M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-It EASE CALL(204)953-7697 <br /> r 61GNED 'I—... _ _ Y-- TITLE �'. G 1♦ DATET\ <br /> \ v / <br /> c � <br /> 0 <br /> J <br /> IT-- - - — <br /> NI <br /> H E MENI <br /> DEPARTMENT PSE 9NLY <br /> Applica i In Accepted By �'E�- Date '71ci/Ol Area Employee IDD UTUU �Cc� <br /> Final lnspeatlon By Dale ❑ SPECIAL PERMIT-ADpmvW by <br /> Character of Soil to Depth oI3.FU PIUSump Sail Character: <br /> COMMENTS rt.rw <br /> i <br /> PE SC Reetived -- Com/ Amount PermtU <br /> Per <br /> Date Invoicep mit lips <br /> na• Code IKPD B Carh RemIHM Service Request N- <br /> 112 .Vg Se/ /�—.[ <br /> 42L2MI ONSITE WASTEWATER PERMIT i <br /> _ <br /> '=O903 <br />