Laserfiche WebLink
' <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY EiNVIRONMENTAI.I I LALTH DEPARTMENT 304 E WE9Ek AVE-3""FI.-`.STOCIC17ON CA 95202 - (209)468-3429 <br /> NON-RFFUNDABLE PERMIT CALL(209)953-7697 rOR IN SPEC•TIONS EXPIRES 1 YEAR FROM DATE 1SS[JED <br /> JOB ADDRESS -� --', C= All - Crl►-fZIP �}'I'C .�, �'� - _ R <br /> ff <br /> CROSS$rREuT C_-f!h^-e-', L t C� APNs , a <br /> OWNER NAME I L o �>�� � PIIONE <br /> Ow-NER ADDRESS � C'IT►'ISTATEIZIP <br /> CONTRAC7•UR _ '�r�I 1 L _ CLL4- 'L-- PHONE <br /> CONTRA[1'OR ADDRESS r( L, [ • CF'rYlSTATF12lP C� <br /> LF('ENSE ❑C42 ❑C-36 01HL:R NIAFAFR � , '3 �'�1 EXPIRATION DATF: <br /> WATER TAR1.F.DEPTH- t) C;EOGR:,PIII(:)L1.TNFORMA I NOti: Coordinates Y Y <br /> LJ FERC TEST'(S) Nl'MOCR LAND USE APPI ICATION# <br /> TYPE OF WORK: ❑ !dew INSTAI.I.ATION ❑ REPAIRIADDIF10% 7 ENGINEER IhSiCNF•D/ALTERNATIVE <br /> I 1 Ci°LACFhiF.N7 ❑ Du%5i,Ruc"rI0N <br /> INSTALLATION WILL SERVE: 0-1rsIDENCE U COMMERCIAL ❑ CYPHER_ f� <br /> NUMBER OF LIVING UNITS_ NUMBER OF BEDROOMS.' NUM6FR OF EMPLOYEES: ] <br /> ❑ SEPTIC'TANK TYPEIMFGALC r C:fL: ['..Pnrrrr / -L:( P-1 it OF COMPAHTMEN 1 S <br /> ❑ CREASE TR,%F TYPuMF-G _ CAPA[TfY gal #OF'COMPARTMENTS y <br /> ,.a <br /> ❑ PKG TX PL A N Y DISTANCE•rO NEAREST: WF LL 11 FOUS DA I ION ft PROPER I Y LINE I t <br /> ❑ LIFT STATION SIZE TYPE OF PIMP ❑ SAND OIL SEPARATOR(ENCLOSED SY51TIM) <br /> a--I ;ACH LINES '11 .ACTHNC CHANIBF.RS >t OF LINES LENGTH OF LINES_,)- <br /> IDISTANCETONEARESI' WFi.I 3 11 FOUNDATION 11 PROPERTY LINE <br /> ❑ rILTER TEED WIDTH ft LFNOT14 , _11 DEPTII _ ft <br /> LDLSTAws To NcA Rm5 WELI- _ f1 E01)',D.ATION (I PROPERTY LINE. f1 <br /> ❑ MOUNDED WIWI" _tl LENGTH _ ft DEI'Ell R <br /> +� DISTANCE TO NEAREST WELL I't F'OUNDATION ti PROPERTY LINT li <br /> �-ir.A]PS WWII ft LE•,NGTH - FLS DzimI <br /> DISI'ANCETO NEAREST WELL ► R r it FOL NUAI1UN fl PRDPERTY LINE -3 f •� _ ft <br /> ❑ DISPOSAL PONDS WID-fx 11 LrNGTHF[ DEP7II _ _ ft <br /> DwANCETO NEAREST WELL _ fl FOL'NDA11UN _ ft PROPER FY LINE 11 <br /> ❑ SEEPAGE PETS WIDTH ft LENGTH _ ❑ DEPTH J ft <br /> DISTANCE TO NEAREST WELL _f2 FOUNDATION 21 PROPERTY LINE _ tF <br /> I HEREHY CERTIFY THAT SHAVE PREPARED THIS APPLICATION AND THE:WORE.HILL BE DONE IN ACCORDANCE:WTTH SAN JOAQUIN COUNTY ORDINANCES. <br /> S-IATF LAWS AND RULES AND RF'GULATIONS OF SAY JOAQUIN COUNTY. <br /> M •IM tiI ZI HOUR ADVANCE-NOTICE REQUIRED FOR INSPECTIONS-PLEAS.CALL(?[141453-7697 <br /> SIGN - L�•t' _ TrrT.F/ �: f t + _- + J t <br /> J. L i t` t4 L- DATF, f �I _J <br /> �~ <br /> f F 4• <br /> I <br /> I Yl <br /> � M1 <br /> UAFL!/ <br /> f f <br /> r <br /> v� NA <br /> 1 N <br /> IT--Frt-lu <br /> r- DF.PARTM N O.' <br /> Applicaliun Accepted By - C Date �• t Area !' Emp4oyee fD#_ f �� <br /> Final Inspection By, C !`< - : Date F "� 11 SPECIAL PERMIT-Appmved by <br /> C'haracter of Sail t$Drplh dr3 FI; Pit[Sump Soil CharmOcr: <br /> COMMENTS4,c a - - <br /> PE 3C RecC'h Arnounl PerMitl <br /> Cudr INFO civ Cas Relnilted ate Service Re uesl It Invoirc ti Permil IDff <br /> Val 1-T <br /> 42-0 I-of)I <br /> hN 5I T'>:WASTEWATER PERMIT <br /> t� <br />