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ONSITE WASTE"'A TER TREATMENT SYSTEM PERMV --I,u <br /> SAN JOAQUIN CCIUNTV ENVIRONMENTAL-HEALTII DC953-7697 FOR INSPE <br /> T <br /> 3114 E WEBER AVE-J"°FL-STOCIc,�,95202 - (209)46&3420 <br /> NON-REFUNDABLE PERMIT ;NW(209) CTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS -1 73Z .7 '- \ <br /> CITYlZIP W <br /> CRIE.KS STREE I C.";� KCF<,^ <br /> QFC,-c <br /> APN f �Ff-i��]["�- PARCEL SIZE ��_F'7 ar <br /> a <br /> OWNER NAM11F. <br /> x PHONE <br /> OW NF.It AOORESS �_ �� ka - " <br /> 1,.F _ CITT/SrATEIZIP <br /> CONTRACTIIR �r � \ _ <br /> ALL PHONE <br /> CONTRACTOR AIIORKSS _ CITI'lSTAT'EJ%IP <br /> LN hrrxl: UI'-42 UI'-lh IInOI f� <br /> ESrIRA'r1oN DATE: <br /> WAi't:R Tn ISI T.DF F1 It C:FIH:RAPPIR AI-INFORMA ITCIN: Caurdinales X <br /> Y <br /> PERC TEST # BIIILDfN(i�- — / _ LAND USE APPLICATION#�� <br /> I ERM1iI'['# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ RF.PALWADDITION <br /> Ll RREPLACEMENT <br /> ❑ ENCINEER DESIGNED/ALTERNATIVE 1� <br /> O DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RECIDENcE: ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIvrw UNITS: NUMRt:R OF BEDROOMS: NUMBER OFF�EM�PL.OvtrS: <br /> ❑ <br /> SEPTIC TANK TVI'E/Mtc­ CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TNTl%r NfH; CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE.TONEAIOE: WELL fl FOUNDATION H PROPERTY LINEfl <br /> ❑ LILT STATION SIZETYPE OF PLMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS of LINES LENGTH OF LINES f[ <br /> D1cTANC'F.TO NEAREST WELL fl FOUNDATION it PROPERTY LINE R <br /> ❑ FILTER BED WIDTH tl LLNGTH R DEPTH fl <br /> D15TANCETONFARFST WEE L- fl FOUNDATION fl PROPERTY LINE Q <br /> ❑ MOUNDED WmTII dl LENGTH fl DEP1 H <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE H <br /> ❑ SUMPS WIDTH R LENGTH i" / fl <br /> DM. ANCE TO NEAREST WLLI. IT FOUNDATION fl R'PER_T9 INE fl <br /> U DISPOSAL PONDS WIDTH R LENGTH R DE R <br /> DISTANCETONEAROff WELL R FOUNDATION �/ PR RTYLINE R <br /> U SEEPAGE PITS NUMBER WIDTH R DEPTH fl <br /> DISTANCE TONFAREsm WEII Il FOUNDATION fl PROPERTY LINE fl <br /> I HF.RF.BI'CERTI FITHAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE 1N ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES.STATE,LAWS AND RF LES AND REGULATIONS OF SAN JOAQU IN COUNTY. <br /> 1f11 U-M Z4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> --PLEASE CALL(209)953-7697 <br /> SIGNED _ �CJJ+ 'T[TL, <br /> r <br /> (" 0EPARTMENT USE ONLY <br /> Application Accepted Ity I�' 1)u[r �+C Arial Employee lfl# 3 /! <br /> Final fnxpeClia By '• _�-_ h _°,,_ Datr r-."�� J ❑ SPECIAL PERMIT-Approved by 7 <br /> Character of Sf a Depth 6 3 FL _ -_ _ __ - Pit/Sump Sail Character: <br /> COMMENTS �- � �=—c <br /> PE SC Received Cbetk#f Anw ml Permit/ <br /> Code INFO By as Remitted Date Service Re uest# Invoice# Permit[D# <br /> 41412.6111 ONSITE WASTEWATER PERMIT <br />