Laserfiche WebLink
'BBI `ONSITE WASTEWATER TREATME11?SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3"°FL-STDGKTON CA 95202 -(209)16&3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 MR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N^ E � o " <br /> JOB ADDRE55 I� 1 r /V CITY/ZIP <br /> D <br /> GROES$T0.EE1' MM f�r� `' APN r Old. � PAR(C�EL SIT`E� p <br /> Owrvea Nwme L I Ct�o 1 P NN lC V I/Da PHONE/ <br /> ` OWNERADDRESS I-7—7 A'Dn S, IET�r�� CITV/SFATE/ZIP E._C/Q o1 <br /> CONTRACTOR / / 1I //� ! M/C PHONE <br /> - Ja <br /> Cl <br /> CONRACfORADDRESf C,,1&TATJZIP (� <br /> -36 OTHER UMBR ^]/3L ` EXPIRATION DATELICENSE 13 C42 ❑C 'IST <br /> WATER <br /> `C <br /> TABLE DEPTH: R GEOCRAPHICALINFORMATION: COOrdiRAUM X Y' <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION IS <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DMIGNED/ALTERNATIVE <br /> IBB, ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ElCOMMERCIAL LIOTHER L <br /> NUMBER OF LIVING UNITE: NUMRE0.0P BEDROOMS: NUMBER OFEMPLOYEES: <br /> C <br /> ❑ SEPTIC TANK TYPFIMFO CAPACITY gal 4 O COMPARTMENTS <br /> 11• ❑ GREASE TRAP TYPE/MFG; CAPACITY gel #OFCOMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREIT: WELL 0 FOUNDATION A PROPERTY LINE ft r <br /> ❑ LIFTSTATION Sim TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLoSEo Svs Fm) <br /> XLEACH LINES ❑ LEACHING CHAMBERS #OF LINES / LENGTH OF LINES 7� It <br /> DISTANCE TO NEAREST WEU.st w� _ FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEFTH It <br /> Baw DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE A <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCETINEARFST WELL ft FOUNDATION ft PROPERTY LINE R <br /> I� SUMPS WImH � ft LENGTH 10 17,1 It DEPTH Z) X21 R <br /> Ima, DISTANCE"NEAREST WELL " •.y)Lft FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH R <br /> DISTANCETO NiSARESr WELLft FOUNDATION ft PROPERTY LINE ft <br /> 5T SEEPAGE PITS WIDTH ---ft LENGTH ft DEPTH_ ft <br /> BaB DISTANCE TO NEAREST WELL _R FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> a STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> S�1�R�ADVANFEIPOrI SQUIRED FORITL INSPECTIONS-PLEASE ALL 953-7697 <br /> � SIGNED UU VV II// TITLE DATE sal-0;3 <br /> 1,r Lit <br /> y <br /> JO O N O <br /> it <br /> r-/ DEPARTMEN3US NNLY <br /> �Application AaepfalB r _U " P Date 2I (� <br /> A. I Employs IDk �� O <br /> Final lnFpectlan BY DataQl ❑ SPECIAL PERMIT-Appmvcd by <br /> Character of Sail to Depth of 3 Ft PIUSump it Character. <br /> COMMENTS <br /> r <br /> PE SC Receival Check#/ Amount - Date Permit/ Invoice# Permi[IDp <br /> e Irmo B ae Remitted SM-A.Re Deet# <br /> v <br /> 0 I 4-z3 00 33913 <br />