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�. <br /> ONSITE WASTEWATE%,REATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT JOIE WEBER AVE-3'°PL-SrocRTory CA 95203 - 09)468-3020 <br /> NUN-REFUNDABLE PERMIT c' CALL 209 953-/7697 FOR INSPECTIONS EFXPIIREJS rI YEAR FROMDATEISSUED <br /> IOBADDRE56 �,Ip VL fl ytlh - Y 1.1 cl/rY[/�zIP ./ IpI���L}I,V 1 l �2I I 3. <br /> 8OM STREET Ul���.I� FLGI I APN ICS• l L+& V',J PARCELSIZE <br /> p O <br /> OR <br /> NAME �II'1� 1V` PHONE <br /> TWNERADDRESS (� ` �{ \ `, +� CRy/STATE/ZIP / <br /> IONTMCIOR I �� A C.V ) t q �V 1 PHONE , - 1 I(, t 1' <br /> "J <br /> COMM A ESS L TCC l' Vin], \I, CEIY/STATEAEP 1 ' <br /> V. <br /> .ICEN3E 0C4 ❑C-36 OTHER NUMBER E%%MTtON DATE <br /> 'WATER TABLE DEPTH: ft GEOGMPHICALINPORMATION: COOTdinatM X Y <br /> PERCTEST p BUILDING PERMIT# LAND USE APPLICATION# L `� <br /> TYPEO—WORK.- ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPMCEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBEROFBEDROOMS: NUMBEROPEMPLOVEES: <br /> l❑ SEPTIC TANK TYPEIMFG CAPACTTT pl #OFCOMPARTMEWS -� <br /> �r GREASE TRAP TYPEIMFG CAPACITY PI NOF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONFAREST: WEILLft FOUNDATION It PROPERTY LINE It <br /> 7 LIFTSTATION SISI TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLUSEDSYSIII i <br /> 401.7 LEACH LINES ❑ LEACHING CHAMBERS #OFLn LENGTH OF LINES H <br /> DISTANCEMNEAREST WELL It FOUNDATION ft PROPERTY LINE ft 79 <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISIANCETONMHEST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> MOUNDED WIDTH ft IENOTII ft DEPTH ft -, <br /> DISTANCE TO NEAREST WELLR FOUNDATION ft PROPERTY LME R <br /> SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCETONEARPSr WELL ft,FOUNDATION R PROPERTY LINE R - <br /> ft❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft - <br /> DISTANCETONEARESr WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCETONMRPbFr WELL ft FOUNDATION ft PROPERTY LINE ft <br /> r <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND WORK WILL Be IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ANCE3� <br /> ORDINSTATE LAWS AND BULLS ANDND SAN REGULATIONS OF SAN JOAQUIN COUNTY. <br /> - MINIMMi 4 HOUR ADVANCE NOTICE REQUIRED FOR I NSPECI'IONS-PLEASE CALL(209)9534697 <br /> F'+:, <br /> SIGNED TITLE; DATE <br /> I <br /> - 'c <br /> N <br /> J p <br /> of O M AL <br /> ( L t <br /> DEPARTMENT U E NLY i+ <br /> Applicatlon Accepted 81 ��' 114:��— Date 7, q GS A. 1 4 EmPlgee IDN <br /> Final lnspeeUDn By Date ❑ SPECIAL PERMIT-APp1oYM by <br /> e haracter of Soil M Depth of 3 Pt: PiUSump Soil Character: <br /> COMMENTS <br /> PE SC R4Pe R, Invoice# Permit IM <br /> Cede INFO CW 'ReWttM 3ervieei <br /> 5i1 �� cr>.Vo �y;/ .;1�L'C:i-{ <br /> I <br /> 42-03,001 ONSDE WASTEWATER PERMIT <br /> ,=U,3 <br />