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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AYE-3-FL-STOC NTIIN CA 9$302 -(309)46&)4]0 <br /> NON-REFUNDABLE`PIERMIT CALL. 20995}.767 POR I N.PECII(ONS EXPIRES I YEAR FROMjDATEISSUED <br /> JOB AOURGSE I1J (� '( �+�+ -C�`. OTY/ZIP rT-' <br /> r• C.0.11RRRET , r'\``1' ` T `APN PARCEL SIZE l r <br /> OWNERNAME � PHONE <br /> OWNT.RADDR-11 CITVISTATE P <br /> CONTRATTOP <br /> Pxon[ <br /> CONTRACTOR ADDRESS CTTVISTATTJZIP <br /> LICENSE ❑CA3 ❑C-3ti OTNE0. NUMBER EXPIRATION DATE <br /> _ WATER TABLE DEPTH: 0 GEOGRAPHICAL INFORMATION: CDO1dB.Y1 X Y <br /> PERCTEST # RUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: O NEW INSTALLATION ❑ REPAIRIADDTON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> O REPLACEMENT ❑ DETTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERGIAL ❑ OTHER <br /> NUMBER OF LIVING UN'TTS: NUMBE0.0F BEDROOMS: NUMBEROF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gel N OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> _ ❑ PKG TX PLANT DIS'TANCETONEARFST: WELL It FOUNDATION ft PROPERTY LINE ft- T' <br /> ❑ LIFT STATION Sin TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SVBTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINFB LENGTH.,LINES ft <br /> DRTANCETONEA. WELL ft FOUNOATR)N R PROPERTY LINE ft <br /> ❑ FILTER BED WEBER It LENGTH R DEPTH ft _ <br /> DISTANCE TO NEAREST WELL A FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL A FOUNDATION 0 PROPERTY LINE ft <br /> a. ❑ SUMPS WIBDI R LENGTH ft DEPTH IT' <br /> DISTANCETONEARF$T WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL FONDS W. R LENGTH R DEPTH fl <br /> DISTANCETONEAREAT WELL R FOUNDATION R PROPERTY LINE 0 <br /> ❑ SEEPAGE PITS NI:MBER WIDTH 11 DEPTH 0 <br /> DISFANCETONEAREST WELL 9 FOUNDATION ft PROPERTY LINE 9 <br /> 1 HEREBICERTIFY THAI'I NAVE PREPARE.THIN APPLIG\TION Al.THE WORK WILL BE DONE IN ACCORDAICE W ITN SAN JOAQUIN COUNTY <br /> (HEI\"I Fl..\I'II I I\\I\I"IHt"I I".1 R11:1 I.ITIII\1 OF J.AQk NC(ItF,N. <br /> w 1 / <br /> SF[:NED"-- I'I TIT, DATE <br /> RMS 19E.CEIVI-ri <br /> BRE, <br /> DEPARTMENTVU,EONLY _ <br /> Application Ar cpfi By Dale 1 T' i/ o%. Alw Empioyce IDS <br /> FROI laspMYm.By Dam ❑ SPECIAL PERMIT-Appmvcd by <br /> cbMNNau orsBH to Depth of 3 FE PINSOmP$ail Character: <br /> COMMENTS <br /> CPE Sc Remived Che 1 A :1 Date Permit/ a# Permit Im <br /> MIN <br /> InTO By Cash Remithtl ServieeR nest# <br /> C"n'JW ONSITE WASTEWATER PERMIT <br />