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/a jv <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN(AUNTY'ENVIRONMENTAL HFALTH DEPARTMENT 304 E WFRF.R AVE•3""F7,-u•OCKTON CA 95202 -(209)460-3020 <br /> NON-REFUNDABLE PERMIT CALL(209)9$3-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADuaLss A(/0 6�Esr. G Z4 Cr—L2��ri/> CrrY/LIP LArlb2W'P '7521C <br /> '231 ,?. 'A' <br /> API <br /> CROSS STREET JL. -_ PARCEL SIZE � <br /> OWNER NAME L, a�9—ArEf�C/ PIIONF. <br /> � L� r �7 y <br /> OWNER ADDRFSY / - L, '�[ n`�j7 �-�� CITY/STATL/Z;fP L IIZyP1 L-AJ XL:,T- G, <br /> CONTRACTOR PHONE <br /> CUNYRACTOR ADDRESS CITY/STATE/4w <br /> LICCNSR ❑C-42 OC-36 OTHER_-_ NLMBER EXPIRATION DATE <br /> WATERTABLEDEPTH:_ 117 /-7— II GEOGRAPHICAL INFORMATION: Coordinates X Z <br /> ❑ PERC TEST A BUILDING PERMIT l# LAND USE APPLICATION IF- NfA <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ZI DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 'J COMMERCIAL ❑ OTHER_ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TVPFJMFC CAPACITY _....� gal A OF COMPARTMENTS_ <br /> ❑ CREASE TRAP TYPFJMFG CAPAcriY gXt 9OFCOMPARTMENTS U) <br /> ❑ PKC TX PLANT DISTANC E TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE, ft <br /> ❑ LIFT STATION SIZE TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSFFM) <br /> ❑ LEACH LINES U LEACHING CHAMBERS A OFLMES LENGTH OF LINES ft <br /> DISfANCUTO NEAREST WCLL R FUIR4DATION ___ft PROPFRTY(JNE R <br /> ❑ FILTER BED WIDTH_ _ft LENGTH__ _tt DEPTH _ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED W'InTH ft LF):rTII ft DEPTH R �- <br /> DISTANCE TO NEAREST WELL_ R FOUNDATION _fl PROPERTY LINE <br /> ❑ SUMPS WIDTH 11 LENGTh R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH_ ft DEPTH R <br /> DISTANCE TO NEAREST WELT. ft FOLIND.ITION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPT II ft <br /> DISTANCE.TO NEARESTWFI.I. ft FOUNDATION ft PROPERTY LINE ift <br /> 1 HEREBY CE FY THAT I HAVE PREPARED THIS APPLICATION AND THF.WORK WILL BF.DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> NANCES,STA"1'E LAWS AND RULES AND REGE LATIONS(IT SAN JOAQUI N COUNTY. <br /> •y.HIN t //JU�R ADVANC.f.NOTICE.REQUIRED FOR INRPF.CTIOSS-PLEASE CALL(204)453-7647 <br /> SI(:NF.D r L T�4./P2� TITLE Bs'�AJFf' DATE <br /> I lull <br /> VI OT <br /> ! it, H H E;kl EN <br /> i P%RTMLNT USE f�N-L <br /> Application Accepted By Date f '2. r7 Area /l i- Employee IDA <br /> Finsl Inspection By DalVA� ❑ SPECIAL PERMIT-Approved by <br /> CharacleT Of SO![10 Depth of 3 Ft: iUSump SOH CharaCItr: <br /> COMMENT'S <br /> PE SC Received eck#/ Amount Date Permit] Invoice# Permit IDM <br /> Code INFO Ry emitted Service Request# <br /> a 1 4 us <br /> z z i fz 'Z <br /> 42-02-00t ONSITE WASTEWATER PERMIT <br /> 1222.2001 <br />