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ONSITE WASTFWATER TREATMENT SYSTFIVi,YERMIT SAN JOAQUIN COUNTY ENVIRDNMENTAL I IEAL111 DE'` J%IEN'1' 304E WEBER AAt `'"Irl.-NTt/('R'1'ON 9S2 ( 2 NON-HEIr11NDARLF: PERMIT j-S(l Til Ll.(2119)95.1-7697 POR 1\'SI'F.("TIONS H;XI'IRI':S I YEA R( I' : NND);D .Ion ADURT:ss - - v/rl— ('rrr/'/.Ir �`r/L/V 15 z I $� V Cuoss STREET -TTLt7 � 7°/ P&efV 7-W-Cn/�-r APN 1�cl- 0C,,- f0'/ PARCELSIZE r. VS��cr, a OWNER NAME Jc'�/.c_-t�'lo oQ_.E„cC ✓�' /1IP�H�/ONE OWNER ADDRESS � -7 S-�n�� 1�� CITY/STATE/ZIP ,' 1 /" CONTRACTOR I�./�iL riJj=fL(�D - PHONE S -( �P CONTRACTOR ADDRESS -Z-V'-Z- 57— / �1�-YZ-�_ CITY/STATE/ZIP e, � T, LV S^• LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATERTABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y Al PERC TEST(S) NUMBER LAND USE APPLICATION# 7-0 5-4 TYPE OF WORK: 13NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT Cl DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION 11 PROPERTY LINE ft ❑ LIFTSTATION SIZE. TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSEOSYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #GF LINKS LENOTTI OF LINES Il DISTANCE TO NEAREST WELL It FOUNDATION @ PROPERTY LINE iZ ❑ FILTER BED WIDTH ft LENGTH R DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYLINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH III LENGTH R DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE fl I HEREBV CERTIFY THAT I HAVE PR THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, TA" ,AWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. IM 1 H 1R DsVANCF.NOTICE REQUIRED FOR INSPPECTIONS-(PLEASE CCALL 12 091 953-7697" SICNEU '1'1'1'12: IZ/VL./n a,;%12 .. I)ATE S J II � N1C I _ 1G HEA1TN.fft HE FN IRO DEPARTMENT 6E0 LYOO / Application Accepted By -�— Date p` i3 Arca .911 Employee ID# Final Inspection By Date / -/0-2!n 1 ❑ SPECIAL PERMIT-Approvedby Character of Soil to Depth of 3 Ft: 'PIVSump Soil Character: COMMENTS 1p4d.1,1� Q7/ wtt y 7L� 9), 4 'e nlj.n.d 'Lvs1 / 17 orf Srf PE SC Received Chec Amount Date Permit/ Invoice# Permit lD# Code INFO By Cash Remitted Service Request# �- S 3 X035 1 zc`7 a2-01-001 112101 ONSITE WASTEWATER PERMIT