Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOLIN COUNT'I ENVIRONb1ENT4l.HFAI.TH DEPARTMENT 314 E WEBER AVE-3"'FL-STdCKFON CA 95202 -(209)468.3420 <br /> NON-REFUNDAHLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE,ISSUED <br /> JOD.A DDaE ssL� <br /> CrrY/LIP <br /> CROSSSTREET �t'prha-i- !�-D - APN 43 - /ht --5-0Z-UZac.YS o <br /> PARCELSIze � <br /> Ol\1[R NnME �( — � PHoNE ut <br /> OWNERADDR1l5,5 `\ CITY/STATEIZIP -+YyIr L 7 ! /�✓'��OC C� <br /> CON•I'RACfON W PNONEL —yljpf �- <br /> ConTaACroa ADDRF.Ss CITY/SFATE/LIP <br /> LICENSE ❑C:-42 O c-36 OTHER _ NUMBER EXPIRATION DATE_ <br /> WATER TABLE DEPTII:_ n GEOGRAPHICAL INFORMATION: Coordinates X 1' <br /> ❑ PERCTEST(S) NUNI.FR LAND USE APPLK:A I ION <br /> TYPE OF WORK: ❑ NEW INSGLLATION ❑ REPAIR/ ❑ ENGINEER MSIGNED/ALTERNATIVE <br /> ❑ RF.PLACEMEN'I DESTRUCTION .ZF4-Q.-k L G(' <br /> INSTALLATION WILL ISERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OnlEay <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NCMBF.R O�EMPLOYEES: <br /> SEPTIC TANK Ts,PFIMFG CAPACITI' gal J QF COMPARTMENTS <br /> ❑ G ETRAP TVP['MPG __ _ CAPACrTY� gal M OF COMrANI ME N IN <br /> LIPKG TX PLANT DISTANCE TO NEAREST: WELL ft FGUNUATION _-- _ n PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS K OF LINES _ LENGTH OF LINES <br /> DISTANCE TO NEAREST WILL R tOUNUATION }1 PROPERTY LINE R <br /> ❑ FILTER BED WIDTH n I FVGTH n DtPTH _ H <br /> DISTANCE TO NEAHEST WELL n FOUNDATION R PRUPENIY LIKE _ fl <br /> ❑ MOUNDED WIDTH R LEruTH_ _n ULPflI <br /> DISTANCE TO NEAHUSI' WELL_ R FOUNDATION__ft PROPtK'IY LINE ft <br /> ❑ SUMPS Wmnt R LENGTH_ n ULFIII _ I1 <br /> DISTANCE TO NEARFSI WELL -11 FOUNDATION- R PROPERTY LINE fi <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH n DEPTII R <br /> DISTANCETO NEAREST WELL__ fr FOUNDATION it PROPERTY LINE _ R <br /> ❑ SEEPAGE PITS WmTH R LENGTH R DEPTH R <br /> DISTANCETONEARESI WELL___ _R FOUNDATION_ft PROPERTY LINE R <br /> I HEREBY CERT"IFlTHAT'I HAVTHIS APPLICATION AND THE WORK WILL DE DONE IN ACCORDANCE WITH SAN JOAQVIN COCNTY ORDINANCES, <br /> TE LAW'S AVD HULFS AND REGU'LAT70NS OF SAN JOAQUIN COUNTY-. <br /> NIMUM 2!N R ADVANCE NOTICE REQUIRED FOR INSPE ONS-PLEASk CALL(209)953-7697 !� <br /> SIGNED '1I"IT.E_ DATE111.1 J10 <br /> OC - <br /> h y' <br /> Ah <br /> IIN,'CIA <br /> SCLI N <br /> IVJF <br /> E fT <br /> - DEPARTMENT Ifs ONLI' f((-.-t.S i r.1(r�yF�t •Ti Ai V- <br /> /- <br /> -a <br /> Ainapplfcatba Accepted By f Date_2 A U Area _ Employcc IDM_ 15`2 <br /> Fl Inapecllon gy-�•��/arl GHJ- k-, .-I lI l f Date Z� r V� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pil/Sump Soil Character: <br /> COMMENTS 7n arm .lam rr� fid{ a s!jA -� IQC4-ft ,_. o.� Le c..`F� �.K/� �3at'-t-w -'fv <br /> �T - <br /> V+-�'.� f C!-¢.'!7 L._ of d v.-., �✓..l71T G -!G .t av�'. .S i n t.(•1 CL�.S <br /> . � r�YYt�G <br /> y�.L .1-��-uc-ri.t n� T.� Q.. <br /> PE SC Received 'hec Amount ate Invoice M Permit IDM <br /> Code INTO g ash Remitted Service Roquest M <br /> 42-24 <br /> 2'T-*+ Scpin J"u oc, o.. pvrrLT l: t , 7, L <.+P� tr Ll- ✓'f <br /> 12-01-DDI .�trC�Vh�(k,. v^t I�.++`L }.- .([ t (+rt.l nu Pv-cj fl+�../ ONSITE WASTEWAI ER PERMIT <br /> 122•102 --7 /y51 Wr Qtv <br />