Laserfiche WebLink
3;15 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3'°FL-STOCRTON CA 95202 -(209)469-3420 <br /> NON-REFUNDABLE PERMIT CALI,(209) 3- 697 FOR I%XPECY1 -0, EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRFSS F e CITY/ZIP P .iv <br /> v <br /> fi x.~ r APN ;9!M-4749.35or , 06e - <br /> CROSS STREET IAPARCEL SIZE <br /> _ y �j e <br /> OWNERNAM£ I_ � ��'�+ ..,._ ,. PHONE$ _ -fin <br /> OWNERADDRFSS Ss�/1^J' CITY/STATE/ZIP _ <br /> CONTRACTOR v �'v PHONE <br /> CONTRACTOR ADDRESS _,. _ CITY/STATEIZIP_ <br /> LICENSE ❑C42 ❑C-36 OTHLR NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST #� BUILDING PERMIT#_ LAND USE APPLICATION# O <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE. <br /> REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Iia RESIDENCE COMMERCIAL D OTHER <br /> NUMBER OF LIVING UNITS' <br /> ❑ ,. NUMBEROF BEDROOMSNUMBEROFEMPLOYEES: <br /> SEPTICTANK TYPE/MFG P0(Jp CAPACn'Y Lwgal #OFCOMPARTM`NTS <br /> i <br /> ❑ GREASETRAP TYPE/MFG _ _ _ CAPACITY _ gal #OF COMPARTMENTS <br /> D PKC TX PLANT DisTANCE TO NEAREST: W LLL_ T FOUNDATION R PROPERTY LINE_ ft <br /> ❑ LIFT STATION SIzE TYPE OFPLNip ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENOTH OF LINES fl S <br /> DISTANCE TO NEAREST WELL ft FOUNDATION___ R PROPERTY LINE ft ` <br /> FILTER BED WIDTH 2S' ft Lr:Nenl�./" � R DEPTH &"1VA k ft <br /> DISTANCE TO NEAREST WF.I.L /��p .ft FOUNDATION O R PROPERTY LINE r S <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH_ •7 fl <br /> DISTANCE TO NT:AREST WELL ft FOUNDATION ft PROPERTY LINE _ R <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE.TO NEAREST WELL R FOUNDATION fl PROPERTY LITE „ R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH tt DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _tt PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH ft <br /> DISTANCE To NEAREST WELL_ ft FOUNDATION R PROPERTY LINE ft <br /> 1 HEREBY CERTIPY-THAT I HAVE PREPARED THIS APPLICATION AND THE WORT(WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> >11NIMIi>f 24 HOLR A/n}A'N(�'F.\wATI(:F RF.Q(IHED I OR 1\SPF.('I 101's-I'f.F.\�F.C'.4LI. <br /> SIGNED, �� � r�� TITLE DATE�'J `� <br /> c <br /> in <br /> T <br /> iD 40' <br /> _ o <br /> to <br /> _ O <br /> K� Id <br /> yOP oN rM <br /> � No�°s� <br /> t� <br /> e Via. <br /> Application Accepted B _ Date.rte- Area Employee IDP_ �� <br /> Final Inspection By ._i Date-�/i#f&b'S ❑ SPECIAL PERMIT-Approvedby <br /> Character of Soil to Dep of 3 Ft: Pit/Sump Soil Character: G <br /> COMMENTS j4-7-, hoj-- ;9� in s:'E c�c,� A411 5Y6,77-:.zl a <br /> PE SC Received Chec!�, Amount Permit/ <br /> Code INFO By 36 Remitted Date Service Re uee# Invoice# Permit ID# <br /> 11;t ffe �?�S'O10 035D 7 6 0 0 2 9G0 <br /> ya=fe <br /> 42.02.001 �/ S�� ONSITE WASTEWATER PERMI I <br /> 1282/2003 <br />