Laserfiche WebLink
�r1�N ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> NNN $AN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT G00 E WAINSTREET-STOCK70N CA 95202-(209)488-3420 <br /> NON-REFUNDABLE PERMIT P4. <br /> / i'aV j I_ EXPIRES 1 YEAR FROM DATE ISSUED <br /> ADDRESS N <br /> JoB • IitNN A N T Ple, • CaymppL-ODI S J-47- <br /> ` '-' <br /> CROSS STREET -r"RNT a N API OS M - 15'0 �7-4f PARCEL SIZE <br /> /� c <br /> OWNER NAME C-/0 Dos Po V�A (Aj/Lc7 N 'CI ri PHONE 3 33-- Z O 4'j <br /> OWNER ADDRESS r '0 • gla^ • + CITYISTATEIZIp `0 1>I.C A 017j 2,A4 I <br /> CONTRACTOR I-IV EO AIL GCOa�N✓11 v19EN TnL PHONE 3b1-03 -s- Q <br /> CONTRACTOR ADDRESS T0� �)' I, CT/ISTATEJZIP II��•`77 • Z� <br /> LICENSE ,C42 C-38 OTHER NUMBER EXPIRATION DATE ' [:�'IPJ <br /> WATER TABLE DEPTH: fl GEOGRAPHICAL INFORMATION: Coordirletee X Y <br /> PERC TEST # Z._ _ BUILDING PERMIT#_ LAND USE APPLICATION# �(\ <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADORK)N ENGINEER DESIGNEDIALTERNATra `C <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER Of EMPLOYEES: \ <br /> ❑ SEPTICTANK TYpcfMfr _ -_----__--_- CAPAOTY---- gal #OF COMPARTMENTS__-- <br /> ❑ GREASE TRAP TTVE/MrG ___ CAPAOTY _ gal #OF COMPARTMENTS_ <br /> DISTANCETONEAREST: WFLL It FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE _ TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> L1 LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL ft FOUNOATION ft PROPERTY LINE <br /> O FILTER BED WIDTH R LENGTH ft DEPTH It \� <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH_ It LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH E DEPTH ft yv <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1\V <br /> J DISPOSAL PONDS WIDTH R LENGTH It DEPTH It <br /> DIST ANCE TO NEAREST WEII. It FOUNDATION It PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH It <br /> DISTANCE TO NEAREST WLLI It FOUNDATION It PROPERTY LINE R ' <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WRIT SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IMU UR ADVAtt�L 11--t K11- _��..+.,� .. -.x(209)903-lb9i <br /> SIGNED INmu [e NS✓IATA"T DATE <br /> If <br /> ► 4L <br /> IIIIIII .a <br /> a � <br /> 1 <br /> DEPARTMENT YSE OPjLY <br /> Applicahon A I Dab 2- Area_. Employee 10# 4 ro <br /> Final Inspection Date - SPECIAL PERMIT-Approved by ��� <br /> Character of Soil t.M3ftt umpSaCharacter.COMMENTS b, "VE: <br /> _ AP� LZ� 2015 <br /> PE SC Reeelwd Chec Amount Permit/ QU,�COp', <br /> Code INFO B Cash Remitted Date Service Request# Invoice N PEFIRR IDS AN JQA QM�N EN <br /> ? 0.` 0 d �AZHUt=YAVTM <br /> N <br /> 4241 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014107 <br />