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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> L SAN JOAQUIN COUNTY E.N%TRONNIENTAL HE.\LTH DEP>RT:VFNT 600E MAIN STREET-ST(X16TON CA 95202-(209)468-1420 <br /> NON-R :111,I JERNII CALL 4209)953-7697F NSPECTIONS EMPIRES I YE:\R FROM DATE ISSI ED <br /> luli <br /> JOB ADDRESS CITVIZIP —y <br /> 'lM,4 CROSS STREET `i � APV f- PVtCEqZ1L S12F. � <br /> ONNEA NA\I£ t 'Ir �F•K 11 HONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> L CONTRACTOR 1 IJ/�111 t`11 PRONE <br /> CONTMCTOA aDD0.E55 <br /> _I �- YII ' 1 YV0 F CRY/STATFJZIP r <br /> LICENSE X ❑ C-36 OTHER_ NUMBERI M__LI EAPIRATION DATE <br /> ` WATER TABLE DEPTH: R GEOGRAPHICALINFOR\L\TI N: Co ldinat6 C r Y <br /> ❑ PERCTEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OFWORK: NEW INSTALLATION O KEPAIR/ADDITION O ENGINEERDESIGNED/ALTERNATIVE <br /> ` R£PLACENIEYT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER- <br /> N ERO LIVINGU TS NUMBS OFBDRO <br /> EGAIS' NLIN(BER FEMPLOYEES: <br /> 4� <br /> SEPI'ICTANK TYPFIMFa CAPACITY Hal #OFCOMPARTMEME <br /> /a1 G <br /> ❑ GREASE TRAP TYREIMFG CAPACITY 'j,•'l #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL B FOUNDATION r� R PROPERTY LINE R <br /> L ❑ LIFTSTATION SIEE — —TYPE OF PUMP ❑ PKGTAPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES a LEACHING CHAMBER. . e 6 #OFLMES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL�. {-fl FOLNDATION_-./GJ/�"1—ft PROPERTY LINE ft <br /> (3 FILTER BED W'mlu ft LENGTH ft DEPT ft <br /> r DISTANCE TO NEAREST WELL ft FOUNDATION B PROPERTY LMB ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DI.STANCETONLAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ SUMPS WIDTH it LENGTH R DEPTH II <br /> DISTANCE TONEAREST WELL B FOUNDATION it PROPERTY LINE ft <br /> IBB, <br /> O DISPOSALPONDS WIDTH ft LENGTH IN DEPT R <br /> DISTANCE TO NEAREST WELL H FOUNDATION it PROPERTY LINE B <br /> SEEPAGE PITS NUMBER I WIDTH It DEPTH —�P-��-�—B <br /> Disr.ANCETONEAREST WELL + R FOUNDATION T ft PROPERTY LME J'F ft <br /> r <br /> 1 HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES, <br /> ��� STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQL'I N COUNTY. <br /> r SICNE4j MIN IUB'2yry �E REQLTRED FOR IN UP^S-PL Ay�209)953-7697 <br /> DATE <br /> PPLIVVV��//�11111.. nn. A ill <br /> F <br /> 1 07 <br /> r <br /> Ul N <br /> PlyL <br /> A, "ENT <br /> r <br /> BOB <br /> r / <br /> r <br /> I <br /> 1 - DEPARTMENT L E ONLY <br /> Application Accepted ` Date Arcs Employee ID#'J'/ <br /> r Final Inspection B T IAteG� 0 SPECIAL PERMIT-Approved by T-7 <br /> Chander of Soil to U #T3 Fe Pius.mp Soil Character: <br /> COMMENTS QIX) lZaV ?l� 0 cagy <br /> L <br /> PE SC Receivd e ` Checld/ Amount Dale Permit/ Imaice# Permit ID# <br /> LCode lxm Casfi Remitted Scni R oeat0 <br /> ONSITE WASTEWATER PERMIT <br /> 4241 <br />