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ONSITE WA`EWATER TREATMENT SYSTEM PERP"T <br /> _ SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL`aePARTMENT JBO E WEBER AVE-3-FE-ST(��[iCA 95202 -(20)O6B-3C20 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRESi'1'EAR FROM DATE ISSUED <br /> JOBADDRESS 5T01 �Cox <br /> 7a1n 110 Lv� CCO/ZIP .ISI PL(! 1 e r 1 �5 LCI [� <br /> CROSS STREET 61�+P, APN 5--350 — IT PARCELSIZE 1 ) tv p <br /> ONTiER NAME U G�ILLL M'11 (FPHONEIn'F S y . <br /> OWNERADDRESS -1(19 1 I IICl L3 CYC 1 CITY/STATL/ZIP AlF Ly,, 46 CTT q�7- <br /> CONTRACTOR LYf 63� ✓-L1T�CA c()t I A S'S 6 C INTONE l <br /> n <br /> � CONTRACTOR ADORCHS IM1 CPNV/STATEILIP <br /> LICENSE 0C4 L1 C-36 OTHER NUMBER EZPlxrnnN DATE -{{ <br /> WATER TABLE DEPTH: R GEOGMPHICALINPORMATION: Cnortllnvtee X Y N� <br /> _ V <br /> PERCTEST p BUILDING PERMIT# LAND USE APPLICATIONp 31 <br /> Y <br /> r F <br /> TYPE OF WORK: ❑ N¢W INSTALLATION ❑ REPAIR/ADDITION J ENGINEER DFSIGNEOIALTERMgTIVE ? <br /> ❑ REPLACEMENT ❑ DESTRumON <br /> INSTALLATION WL SERVE: LI RESIDENCE ❑ COMMERCIAL ❑ OTHER /O <br /> NUMBEROP LTVIILNG UNITS: NUMBER OF BEDROOMS: NUMBEOUTEMPLOYEEIG C <br /> ❑ SEPTICTANK TYPF/MFG CAPACITY gel A OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPF/MFG CAPACITY gel #OFCOMPARTMENTS <br /> ❑ PRIG TX PLANT DISTANCE TO NEAREST: WELL It FOUNDATION R PROPERTY LINE a <br /> ❑ LIFT STATION SIZE TYPEOPPVMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES a <br /> DISTANCETONEAREST WILL ft FOUNDATION R PROPERTY LINE fl <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL. H FOUNDATION A PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH n DEPTH R <br /> DISTANCE TO NEAREST WELL H FOUNDATION ft PROPERTYLINE IF <br /> ❑ sumps WHOE ft FIDDLE IF DEPTH ft <br /> DISTANCETONEAREST WELL B FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSALPONDS Wmix Fl LENGTH ft DEPTH B <br /> DISTANCE TO NEAREST WELL It FOUNDATION H PROPERTY LINE 0 <br /> ❑ SEEPAGE PITS NDMRER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL A FOUNDATION a PROPERTY LIFE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> I/NIMU ZA HOU R ADVANCE NOTICE REQUI RED FOR I NSPECTTII�ONS-PLEASE CALL(209)953.7697 <br /> �` '- <br /> SIGNED A TITLE LCN(11 H"/✓enS` DATE <br /> i 1 <br /> EI <br /> iP <br /> i <br /> 1 2J ' yo <br /> 3 a <br /> C,I unma <br /> y� i''�ii-ii 2� ��E9T 7E 1 i J a <br /> NJ Nd ' L1a HI 'ii ti� yB N O UNE <br /> w w w n w w es _ <br /> o I_, <br /> I,NO <br /> 41{'c TFy 3 aL <br /> i <br /> DEPARTMENT USEONLY ` - <br /> APPlicvtlonAaepletlBYy� 1�.� �^ "� C. Data ZTrr Aru G I I EmpIDYu 1D# YL <br /> Final lnTpedion By ,_ DAR, ❑ SPECIAL PERMIT-App <br /> Charvcter of SDiI to Depth of 3 Ft PItJSomp Sell Ch.CREIE: <br /> COMMENTS <br /> PE SC Recei,e4 a Amount Data ]RETIRED Invoicep PerrnRlDU <br /> a C R, USED, /BY� Ea. RUNDE IF 6 &MD.R ueM IF <br /> 9J <br /> l1 <br /> 42-02401 AT-_yU Pr_ ONERE WASTEWATER PERMIT <br />