Laserfiche WebLink
Nom^' <br /> ONSITE WASTEWATER TREATMENBT SYSTEM PERMIT CA n2B2 - (209 �6a��20 <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> NON-REFUNDABLE'PERMIT CALL <br /> CALL.(209)953-7697 FOR INSPECTION% EXPIRES I YEAR FROM DATE;ISSUED <br /> JOB ADDRESS LJ / CrrY/ZIP r UC 1 m <br /> !2a QPARCEL SIZE <br /> r O Q <br /> CROSS STREET l 1C ` APN?i�q- = <br /> OWNER NAME r Jl tiv,C1 PHONE Gi <br /> - - <br /> CITYISTATEIZIP <br /> OWNER ADDRESS <br /> CONTRACTOR C� �1Y • I ` PHONE L` <br /> CONTRACTOR ADDRESS CrrY/STATElZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMB£N EXPIRATION DATE_ <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INPORMATION: CoordlRatel X Y <br /> ❑ PFRC TEST N BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L) NEWINSTALLATION k6N REPAIR/ADDITOON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: )!l NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG rt CAPACrTY 1 Zola gal NOF COMPARTMENTS__ <br /> ❑ GREASE TRAP TYPFIMFG _ _ CAPACITY _ gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCF.TO NEAREST: WELL -� it FOUNDATION 1, it PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSEr)SvsTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS__ #OF LINES�, LENGTH OF LINES MDQ ft <br /> DISTANCE TO NEAREST WELL CC) it ET)tINDATTON �ft PROPERTY LINE J1.7 '} it <br /> ❑ FILTER BED Wltrrx ft LENGTH 0 DEPTH --ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION H PROPERTY LINF. _ft <br /> ❑ MOUNDED WIDTH fl LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEARFM WELL It FOUNDATION R PROPERTY LINF ft <br /> ❑ DISPOSAL PONDS Wmrx ft LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION 0 PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMRER WIDTH —ft DEPTH --—ft <br /> DISTANCETONEARF.ST WELL fl FOUNDATION it PROPERTY LINE 0 <br /> 1 HEREBY CERTIFY THAT I PREPARED <br /> APPLICATION <br /> AND THE ORKWILL <br /> S EINCDAEITH SAN JOAQUIN COUNT <br /> ORDINANCSTATE LAWSAND ES AND REGULATIONS OF NA INCOUNTY. <br /> Hl AD'•VNC'P 'O 7:R l FU FOR INSPECFIONS--PPLE:ASF.CALL 11(19)953.7697 <br /> SIGNED <br /> TITLE DATE <br /> I - <br /> ik <br /> I <br /> LYdf 7iaL <br /> r <br /> T- <br /> r <br /> N WIF )N AE JT1 <br /> HE A. r M <br /> v DF.PARTMF.NT I. ON �� <br /> Application Accepted _ _ Fate Area _ Employee ID# <br /> Final Inspection B Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soll to De of 3 Fl:_ Pit/Sump Soil Character: <br /> COMMENTS �(� C� L� !tr if P- 440 <br /> � -- <br /> PF SC Recelved Ch3sklu- Amount Date Permit/ Invoice Permit IDN <br /> Code INFO B Cash Remitted Service Rquest# <br /> ZOO r_ �9 3ti OZ <br /> ONSITE'A ASTLW'ATER PERMIT <br /> 41-n2-00I <br /> �,»•,mz <br />