Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEMYERMIT 00 <br /> Nj(Mw2uNTYENVIRONMEWAL HEALTH DEPARTMENT . 304E WEBER AVE -3"FL-STOCRTON CA 95202 - (209)466-3420 <br /> DN-REFUNDABLE PERMIT CALL 209 $3-7697 FOR.INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> BADDRE55 CrrYrzAP I4wt,,, ` y <br /> loss STREET eeid a Am APN '00-7 <br /> O/�U PARCEL SIZE S p <br /> 0 <br /> NNER NAME s. �- �'� k PHONE H <br /> NNERADDRESS CITV/STATFMP <br /> XRRACTOR L PHONE <br /> )NrRALTORADDRESS '7/J/X) FgM/'�- CITY/SFATFIZIP G <br /> CENSE C42 ❑C-36 OTHER NUMBERIt-/zZY,Auf EXPIRATION DATE <br /> ATERTABLEDEPTH: ft GEOGRAPHICAL INFORMATION: CDDrdlDalel X <br /> I PERC TEST If BUILDING PERMIT# LAND USE APPLICATION# <br /> YPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDFFION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> ISTALLATION WILL SERVE: Q RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS:' I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> I SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> I GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> I PKG TX PLANT DLtiTANCETO NEAREST: WELL R FOUNDATION ft PROPERTY LME R <br /> I LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I-LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES No' ft <br /> DISTANCE TO NEAREST WELL��_ft FOUNDATION 'r� � R PROPERTY UNE CO ft <br /> 1 FILTER BED wum ft LENGTH It DEPTH ft <br /> DtsTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> 1 MOUNDED WIDTH R LENGTH It DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> I SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCETONEARM WELL ft FOUNDATION ft PROPERTY LME ft <br /> I DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft y <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> L SEEPAGE PITS NUMBER .moi- wHITH w.I R DEPTH C2S ft <br /> DISTANCE TO NEAREST WELL /75 " R FOUNDATION /011- ft PROPERTYLME S3� R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY X <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY: / <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> IGNED TITLE DATE <br /> C <br /> uli - <br /> WIT III <br /> U <br /> N <br /> H E <br /> G <br /> O o / <br /> a <br /> -5-5, n <br />