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ONSITE WASTEWATER TREATMENT SYSTEM PERNIIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HGLTN DEPARTMENT 304E WEBER AVE-3-FL-STOCKFON CA 95302-(109)46&3630 <br /> NON-REFUNDABLE PERMIT CALL(209)951-7697 FUR INSPECTION6 EXPIRES YEAR mom DATE ISSUED <br /> JOB ADDRESS ( (1 2 U,c r \ —I e/. -, \— CITxIZIP h C F —`^ rl�' j ZA <br /> CROSS STREET /^'{ APN d� /"l L�'- I� PµA/RC^EL��S//ELE "t)=' /k� �L7. p <br /> ` 0".R NAME I 'A l'lPNONE �{' Z^G , 9 <br /> OWNERADDIMIN CITYISTATEIZIP <br /> coxa ACTTIR ''I ! PHONE Z to q <br /> BOB CONPWCURADDREfifi CHVISTATEIZIP <br /> 1 <br /> LICENSE ❑C-01 0C-36 OTHER NUMBER EXPIRATION DATE - <br /> WATERTABLEDEPTN: R CEOGRAPHIGLINPORMATION: Coordinates X Y� <br /> Pz PERC TEST # kD BUILDINGPERMIT# LAND USE APPLICATI0N# UVA1(-Pn�. � <br /> ` TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDTON .° ❑- ENGINEER DESIGNED(ALTERNATIVE J <br /> ❑ REPLACEMENr ❑ DESERUCTION <br /> INSTALLATION WILLSERVE: ❑ RESIDENCE - "❑ COMMERCIAL ❑ OTHER <br /> NUMBER OP LIVING UN.: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ' <br /> ` ❑ SEPTICTANK TYPE/MFG CAPACITY - gal #Or COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONGREST: WELL - R FOUNDATION ft PROPERTY LME R -T <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCITTEDSYSEEM) <br /> ❑ LEACH LINES ❑ LEACHINGCHAMBERS #OFLME$ LENGTHOFLINEE A <br /> G.- D16TANCETONEAREST - WELL IT FOUNDATION f[ -PROPERTY LINE R <br /> ` ❑ FILTER BED WEEN B LENGTH R DEPTH R <br /> D161'ANCETONEARJG, WELL R FOUNDATION It PROPERTY LIN, _R <br /> ❑ MOUNDED WIBTM R LENGTH R DEPTH R <br /> DisruSCETONEARE\T WELL R FO1fNOATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTN R LENGTH R DEPTH ft <br /> DBYANCETONFARE6T WELL R FOUNDATION - R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH '-R DEPTH___ ft <br /> DISGNCETINELREST WELL ft FOUNDATION H PRDPLRTY LINE R <br /> 1 ❑ SEEPAGE PITS No./.. WIDTH - f DEPTH. R ii <br /> Di ANCETONGREST. WELL ft FOUNDATION R - PROPERTY LME R <br /> I HEREBY CERTIFY THATI HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY� <br /> ORDINANCES STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY <br /> MINIMUM EI <br /> HOUR ADVANCE NOTICE,,R//EQWRED FOR INSPECTIONS-PLEASE CALL(109)95)-]6aT <br /> SIGNED Tom--- TITLE C- ..1"l-n .-�� DATE <br /> l <br /> I <br /> 6. <br /> Yft N N <br /> 1 <br /> I 5 � <br /> i <br /> I \ <br /> APPIIraWn ATcepted BY (j,/GI(, � �(� Dvte /OP// 1 Area ^� Employee lDM ...:E-�- In <br /> FIRM <br /> FIRM lnapeeClan By Data ❑ SPECIAL PERMIT-Approved by <br /> ChRrMAar of SoH W DeplE of 3 Pf: Piusump Sail Character:. <br /> COMMENTS Nn'/r �✓£ 17, c,ir.a' rf:pq.,,3 <br /> L PE SC ReM I CIIedifU Amnun[ Dvte <br /> Par III <br /> Invoice# Permit lDp <br /> Code Inro B -IGiA RemiOed Service Ae uert# 1 <br /> i. <br /> q3-0]-001 ONSITE WASTEWATER PERMIT <br /> ` 1=001 <br /> I✓ <br />