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ONSITE WA" 'WATER TREATMENT SYSTEM PERM- <br /> ` SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTr'`#A0''RTMENT 304E WEBER AVE-3"Xft-JTOC�._/A9520J-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(20 95}7697 FOR INSPECTIONS EXPIRES I nR PROM DwTE ISSUED <br /> y <br /> JOB ADDRESS- ',) r E CITYAMP l <br /> 'CROSS SFREED' APN PA aCEL EtS <br /> e <br /> ` OWNERNAME PHONE N' <br /> OWNERADDREES ) CITYISTAT$lAP <br /> CONTRACTOR 1^ PHONE <br /> � CT'/3'fATPJZIP <br /> CONTRAcroR ADDaess <br /> LICENSE- ❑442 ❑C-36 OTXER NUMBER EXPIRATIONDATE <br /> WATERTARLEDEPTH: ft GEOG PHICALINPORMATON: CoortiMlea X V <br /> i 3 FERC TEST # BUILDING PERMIT# LAND USE APPLICATION#1'. -'�7' I "S <br /> TYPE OF WORK: ❑ NEWINSTALLATION ❑. MrAWADDFOON ❑ ENGINEERDESIGNEDIALTERNATFVE <br /> ❑ REPLACEMENT ❑ DE4'rRUCDON <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTRER <br /> N L U - N B - NumieROV EMPLOYEPS: <br /> ` ❑ SEVOCTANK TYPFJMTG CAPACRV SeI "COMPARTMENTS <br /> ❑ GREASE TRAP TYPCMFG - " " CAPACITY Bal NOFCOMPARTMENTE `N <br /> ❑ PKG TX PLANT DISTANCETONEAREST:_WELL it FOUNDATION ft PROPERTY LNE R V� <br /> LJ LIFT STATION SIZE- TYPE OT Pume ❑ SAND OIL SEPARATOR(ENCLOEEDSYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS - #OFLDIPS LENGTH OP LNES R <br /> DISTANCETONEAREST WELL - R FOUNDATION R PROPERTY LIKE R h <br /> ❑ FILTER BED Womm - ft LENGTH ft DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LIFE R C. <br /> ❑ MOUNDED WUTN - - _ft` LENGTH R DEPTH R -r.f. <br /> DI.SrANCETONEAREST- WELL R FOUNDATION it PROPERTY LNE R <br /> _ ❑ SUMPS. WUU,U ft LENGTH --It DEFT R <br /> DISTANCETONEAREEL N"ELL__ it FOUNDATION - R PROPERTY LIFE R <br /> ❑ DISPOSAL PONDS WIDTH - ft : LEN6111 ' ft DEPTH R <br /> DISTANCE TO NEAREST. WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS 'NUMBER WIDTH it DEPTH R <br /> DISTANCETONEAREST PEIL R FOUNDATION - R' - PROPERTY LIFE R <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 /> M INIM U MEN HOU R ADVANC=E REQ511 RED FOR INSPECTIONS PLEASE CALL(209)953-7697. <br /> SIGNED\-I .��. --� �� TITLE ��,�C DATE 11 <br /> 1 <br /> Rea / - PAACI. <br /> l <br /> an <br /> TgeYp.Itev. BR <br /> Ron -1 <br /> L', 7 <br /> J A UI U <br /> of a= <br /> AIs9T ReON:ROAD 8�p <br /> 1iI CCw DEPARTMENT USE ONLY IDN <br /> Application Accepted By �� Dat -Iv--1 A. Employee <br /> Finallnrpeclion By Date - ❑ SPECIAL PERMIT-Appmveaby <br /> Character of Soil to Depth Of 3 Ft: PHISBmPSoil Character: <br /> COMMENTS <br /> PE SC Recelve1 CM1echM/J Amount Data Perm1U Invoke# Permlr IDA <br /> Coae INFO B Carh Remined ServkeR ump <br /> Sn �V �, LI `Y320 At�Ai/dl CCI) 4 k' <br /> ONSITE WASTEWATER PERMIT <br /> a2-N2 l <br /> + Ina 7 1 <br />