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� ONSITE IFE RTRErpATMENT_E SYSTEM PERMIT'"" w
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<br /> `COUN� VIRONME?N,TA4 HEALTH DEPAR7'Ms,.�`e1304:E WEBER:Ayx-E 3 .ALS�OC1e'CON �2 (209)46&7420
<br /> ,1VON.;R£FUNDABLEPERMITw.F__. _ CALL:.209,4$�=76�7.f'OR•I4SPECT;10'�ti - _�.EXPIRES•1,YEAR FROM DATE°ISSUED' °
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<br /> 1 V s LICENSE ...'s❑C�2 r„ ❑;C 36 OTH£R ��ri Wr _ NUMBER ^+-�+�: "- 'F""R"^ EXPIRATION DATE
<br /> �- )•. '�F WATERITA6LE'DEPTH .�s c + +` .-�>ft GEOGRAPHICAL INFORMATION, .Coordinates
<br /> f' FERC TEST .psi imZ lira' 4 -_Bi71LHING�EERMIT Z �•.zLAND'USE APPLICATION LFA I:E Li'
<br /> -aTY�P,,,••EOP WORK CI.,.,- NEW INSTALLATION"' far -❑J Pip
<br /> AIRlADDITION ❑1-�e,ENC1NEE1t DESIGNED(ALTERNATIVE
<br /> REPLACEMENT „.DeSrRucTwlr
<br /> o-INSTALLATION WILL-SERVE ❑ RESIDENCE y , COMMERCIAL '� ❑ OTHER
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<br /> r * �':NUMBEROFLivl;G UNITS ^{a - .'�'�” NUMBER OF BEDROOMS' ' ."" - Y (NUMBER OFEMPLOYEES:Y .. S, .v.a.. F '�. r _ ' !'Taff a,.,
<br /> ❑ -SEPTIC TANK TYPF/MFG !< '` I� tCAPACITY ,y'gal 4 O COMPARTMENTS
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<br /> k°PKC TX.PLANT y 44 MSTANCE TO NEESTARi...WELL PERTYFOUNDATION " `7 t}- R ;�PAOLME
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<br /> ❑? LIFT STATION 51zE u:TYPE Oa PUMP . ' ° ❑ SAND OIL SEPARATOR(ENCLOSED$YSrEMy -10r
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<br /> ❑ :MOUNDED.. WIDTH f @ ; LENGTH .. ft Y 'DEPTH -
<br /> I} 'DISTANCE TO NEAREST WELti R FOUNDATION fl PROPERTY LINE R
<br /> ❑.,-°SUMPS-. .WIDTH---- ft'.�LENGTH- -I.,,ft,. DEPTH ft
<br /> _ E "DISTANCETONEAREST WELL-' - $ FOUNDATION ft PROPERTY LINE ft
<br /> I �i C] .DISPOSAL PONDS-WIDTH R r,g[ xGTHn¢.- '' r -�.-:a:.�•rr.... ..Fx ,...ft' DEPTii - R
<br /> yl, DISTANCE TO NEAREST WELL _ R FOUNDATION` -f R PROPERTY LINE R
<br /> ❑ SEEPAGE PITS NUMBER WIDTH '- ft DEPTH ft
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<br />+ !' 1 HEREBY CERTI PY THAT'I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY
<br /> ORDINANCES,STATE LAWS ANDRULESAND REGULATIONS OF SAN JOAQUIN COUNTY:
<br /> INSPECTIONS1I�r+A1UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9537697 �—
<br /> SIGNEDr7f'� .t �_. TITLE C!-l:'?rP f''�'F DATE
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<br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by
<br /> ' Character of 5011 to Depth of 3 Ft: Pit/Sump Soil Character:
<br /> I COMMENTS
<br /> PE ` SC Received F�eN Amount Pe IV
<br /> I Code INFO B Cash -Remitted Date Service R uest# Invoice# Permit ID#
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<br /> 42-02-001 ONSITE WASTEWATER PERMIT
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