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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT I <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AYE-3"FL-STDCKTON CA 95202 - (209)06&3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 POR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS S- -S' CITY/!Ar m <br /> CROSS STREET �i.�IttAI PJ✓ APN or)79��� '3 PARCELSIZE .34feF.S <br /> OWNER NAMEPHONE �pJ� i <br /> OWNERADDRESS TYI <br /> CISTATE/ZIP� J/ <br /> / 4fw/ 1 <br /> T_ I <br /> CONTRACTOR WIG. lqdkw4c Zia PRONE <br /> CONTRACTOR ADDRESS CITYMATE/ZIP <br /> LICENSE 0C4 ❑C-36 OTHER NUMBER EXPIRATIONDATE OMB <br /> WATER TABLE DEPTH: ft CEOCRAPHICALINFORMATION: CourdNdeS % Y <br /> ❑ PERCTEST M BUILDING PERMIT# LAND USE LIGATION ik 1 <br /> TYPE OF WORK: 0 NEW INSTALLATION O REPAIRJADDTD N %❑ ENGIN EER DESICNEDJALTERNATIVE <br /> O REPLACEMENT D N - <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMEIlC1AL f— x <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: -- B OES <br /> ❑ SEPTIC TANK TYPU/MFG CAPACIT Permit Mao haAtmaomd <br /> ❑ GREASE TRAP TYPEIMFG CAPnC Work heing000myf�AbHim <br /> ❑ <br /> PEG TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATI �) P- I T1LQIl11 ' R <br /> ❑ LIFT STATION Slu TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSEDS M) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS BOFLINES \ LENGTH OF LINES ft i <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE it <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DwANCETo NEAREST WELL R FOUNDATION ft PNOPERTYLINE R <br /> ❑ MOUNDED WIDTH R LENGTH A DEPTH R i b <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE ft I7 <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCETONEMIPST WELL0 FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH-ft LENGTH R DEPTH ft <br /> DISTANCETONEAHEtT WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUmasm woom ft DEPTH R O <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY jO <br /> .S ORDINANCES�S TE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �`VJT1U HO 1 ANCE NOTICE REQUIRED FOR IN.SPF.C/ ONS-PLEASE CAI 1.(209)953-7697 <br /> SIGNED p-(Q�, TITLE�}/`_ (� DATE <br /> l <br /> IA <br /> 1 <br /> S <br /> Dy IN 0 <br /> �_._._�'_- _ •"-"'� ..A.e'-DEPA'RTMENT° E NUV—.'�^`-`-- <br /> iApplication Amepted By Date 0% Aloe Employm IDR 'i'o / l <br /> j,- FIW lmpMion By Dade ❑ SPECIAL PERMIT-Approved by <br /> i Character of Soll to Depth 60 Fc Pit/Sump Soil Chander. <br /> COM EN S S IBES v^ it fw <br /> PE Isc Received CheeWl/ Amount a e erml Inv ce ermit IDN I <br /> Cade Ingo B u Remitted Service Re uestq <br /> 4 2-Z4 CVIS �[ 00.017 /f Q r <br /> / <br />