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I, ONSITE WA EWATER TREATMENT SY1,EM PERMA4hFED SAN JOAl COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3RD Fill STOCK (209)468-3420 NON-REFUNDABLE e7P^E�RMIT` �n `"...CALL 2001 953-7697 FOR INSPECTIONS. EXPIRES 1 YEAR FROM'DATE ISSUED 2 F f 1 N �r-A� F _.. CITY/ZIP 41� - 1'_J 1 J JOB ADDRESS AA ] h �7�} r H I CIL STREET Ii 1{ Oki [ f� APN .7 Ceff PAR L'S1 E I n I OWNER NAME J�TJ►C V+ , A�gIpU b PHONE 'OWNERADDRESS C 70 PJ, r �I� 9-1 CITY/STATE/ZIP CONTRACTOR ya PHONE 3 II ' CONTRACTORADDRES$ - Zan CITY/STATE/ZIP 1-14 II !i I? LSCENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERM IT# LAND USE APPLICATION# I TYPE OFWORK: T❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEERDESIGNEDIALTERNATIVE ' !I �j ❑ REPLACEMENT ❑ DESTRUCTION i 1NSTALLATiON WILL SERVE:: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER �i NUMBER OF LIVING UNITS. NUMBER'OF BEDROOM$: NUMBER OF EMPLOYEES: O. SEPTIC TANK TYPEIMFG CAPACITY gal #OF,COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS , j ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft I ' ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) i ' ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF�LINES ft ,I � DISTANCE TO NEAREST WELL fit FOUNDATION ft PROPERTY LINE ft I `I ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft I DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft f ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft I DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑, DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft I' II!I DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft I I HEREBY.CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 r �, SIGNED T37LE '•, `DATE � I � I j _ , � OZ .0i , s � �1 0 PqM�` Application Accepted By Date 5- Zi U 7 Area Employee ID# i YC7i Final Inspection ByC. r, Date 2 r 11 SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft:' Pit/Sump Soil Character: ,. I; COMMENTS y �' C s�� 1154C � - �, G0.)2 / /;L-4 z ��)1 14 -�Y—,5 � i i'PE SC Received Check#! Amount Date Permit! Invoice# Permit ID# Code INFO By_ Cash Remitted Service Request# I �I I 42-02-001 !7>titJ lv r b r �' ONSITE WASTEWATER PERMIT