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ONSITF 7ASTEWATER TREATMENT SYSTE" -PERMIT I•'3m <br /> SAN JOAQUIN COUNTY ENVIRONMENT,...�%LTH DEPARTMENT <br /> NON-REFUNDABLE PERMIT304 E WEBER AVEL-STOCKron CA 95202 - (209)46&3420 <br /> JOeADDRESS <br /> CALL 209 953-7697 FOR 1NSPECTIAWe EXPIRES 1 YEAR FROM DATE ISSUED Z s� <br /> r � `J�G � <br /> CROSS STREET <br /> CITYIZIP j, <br /> APNY 2$ cl - J L:� <br /> 11 3 PARCEL SIZE C <br /> OWNER NAME <br /> m PHONE <br /> :rPnn <br /> OWNER ADDRESS I �i J_ k _� a N <br /> ClTV/STATEIZIP�,[-� <br /> CONTRACTOR lV611. <br /> PHONE <br /> CONTRACTOR ADDRESS <br /> fftATE12IP <br /> LICENSE LJC-42 ❑C-36 OTHER NUMBER <br /> EXPIRATION DTE <br /> A <br /> WATER TABLE DEPTH: R GEOGRAP114CAL INFORMATION: Coordinates X <br /> La PERC TEST # Y <br /> BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION N <br /> ❑ REPAIR/ADDTTION 13ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> NUMBER OF EMPLOYEES: 10 <br /> ❑ SEPTIC TANK TYPElMFG <br /> CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG <br /> CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #DF LINES LENGTH OF LINES <br /> ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION _ ft PROPERTY LINE fl <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 4 <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE (j <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft �? <br /> DISTANCE TO NEAREST WELL '- ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WMTH ft DEPTH R <br /> DISTANCE To NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> sp <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND'HE WORK:WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY: <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPEC'T'IONS-PLEASE CALL(209)453-7697 <br /> SIGNED TITLE 4!, DATE <br /> yr w,.iE 1 <br /> ..--.---... <br /> mom-e P I l �- <br /> as -a- 'F' <br /> alL <br /> Ma- <br /> N <br /> �O <br /> r• <br /> r <br /> DEPARTMENT U NL <br /> Application Accepted 8y Datee) Arca Emp3oyec IDN <br /> Fkrii1'luspectioa By Date X -,X l L'9 0 SPECIAL PERMIT-Approved by <br /> Character of Sell to Depth of 3 FI: pit/Sump Boll Character: <br /> COMMENTS <br /> PE SC Received Ch Amount Permkti <br /> Date Invoice# Permit ID# <br /> Code INFO Cash Remitted Service!zest# <br /> )-Z 7,21 Op 00 1 �3 <br /> 4?-02-00] ONSITE WASTEWATER PERMIT <br />