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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQWN COUNTY EWHIDMINTAL HEALTH DEPARTMENT 600 E MAIN STREET.STOCXTON CA 96202-(209)466.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOSADDRESS 29000 A/. 111 AC"ILL-E AD . o"rzip CL.CM E^.rT$ a <br /> CRosSSTREET COyOTp- C*-eeIL APN 0 "1-I f0'O-1 C PARCEL SIZE 31k Ac- p <br /> OMTER NAME i 111•x-4 URI.; EISE.R- PHONE 37-J -9I1- <br /> O.mERADDNass 12-95- 2. PfL--n EYL f2.D- CITYISTATEF2IP hcATN.PQ C-A �I1 LZo <br /> CONTRACTOR UJG DAY— GL.OE.fJVi oIsJmEn/77YL- PHONE 3(A 1-037f <br /> CONTRACTORADDRESS w• OAle-. LST• CFYfSTATE/LP <br /> LICENSE C42 ,Ca Ormea NUMBER ExPIRAnoN DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> PERC TEST M BUILDINGPERMITM LAND USE APPLICATION# (� <br /> TYPE OFWORK: NEW INSTALLATION REPAAUADbITION ENGINEER DESIGNED IALTERNATNE <br /> REPLACEMENT DESTRUCTION /''� <br /> INSTALLATION WILL SERVE: RFINIENCE COMMERCIAL OTHER 01 <br /> IVI <br /> NUMBER OF LNG UI118: NUMBEa OF BEOROOMa: NUMBER OF EMPLOYEES: j O <br /> 0 SEPTICTANK TYPEA" CAPACRY gal MOF COMPARTMENTS <br /> O GREASE TRAP TYPEIMFG CAPACITY 901 BOF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION It PROPERTY LINE ft <br /> O LIFT STATION SIZE TYPE OF PUMP ❑ PKGTXPLANT O BAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES LEACHING CHAMBERS #OFLINEa LENGTHOFLINE6 R <br /> DISTANCE TO NEAREST NiFr i ft FOUNDATION ft PROPERTY LINE ft <br /> O FILTER BED WmTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST HELL It FOUMTAl10N ft PROPERTYUNE R <br /> O MOUNDED Wmm ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST MELT R FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS WMTX ft LENGTH R DEPTH ft <br /> DMTANCE TO NE/.REST M I-L R FOUNDATION ft PROPERTY LINE R � <br /> O DISPOSAL PONDS WmTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NZAIRBT MOLL ft FOUNDATION R PROPERTY LINE ft <br /> -- 0 SEEPAGE PITS WEISER WmTH It DEPTH R <br /> DISTANCE TO NEAREST P.ELL R FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I RAVE PREPARED THIS APPUGTION AND THE WORK WILL BE DOME IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAMB AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> NIMU HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE C#nf6 V L'TM DATE <br /> PAYMENT <br /> RECEIVED <br /> OCT - 72011 <br /> SAH JOAQuw ccul <br /> EWPONMEHTAL <br /> HEALTH Oc PARTMEINT <br /> PARTMENTUSE NLYI.IrCIAL <br /> Applkakon Aecepbod BY DOES VEmployeeID# <br /> Flnal Inspection By OatsT-Approved by <br /> Chomw of Soil b Depth pf 3.F1, PIUSumD Soil CB meter. <br /> COMMENTS - L 3 <br /> PE BC Rocoh, Che Amount Wb Pelmit/ Invoice# PSImkID# <br /> Cods INFO SSh RSmKted Servba oast# <br /> 03 b <br /> 42-01 pI5J1E WASTEWATER TR7MNTSYSTEM PERMR <br /> 10'LO7 <br />