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ONSITE WASTr ATER TREATMENT SYSTI+^I PERMIT SAN JOAQUIN COUN'T'Y ENVIRONMENTAL HEALT'It Dt,,,.,.MF,NT 304 E WEBER FL S'FOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPE('TIONS EXPIRES Uwaq DATE ISSUED JOB ADDRESS 11LP5I E. akH ALN-tDE CITY/ZIP ? / rn CROSS STREET YI LL�JT 1 lam( ANN /�. 7} D 92 b� PARCEL SIZE v r�rnn OWNER NAMEk.� AOMMo ITE� PHONE OWNER ADDRESS /DX .' CITY/STATE/ZIP1` 1017 CI'T 45.b53 CONTRACTOR ��/o Dcsl D , N��,/ �c/-r�EG� //E✓L- PHONE ��`7 S�S' CONTRACTOR ADDRESS �✓ 14-4 "�%E TT ��(��T CIT}'/STATE/ZIP tI A q� g LICENSE. ❑C-42 ❑C-36 (7MER G � � � NUMBER EXPIRATION DATE. Z WATER TABLE DEPTH: fl GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION El/ENGINEER DESIGNED/ALTERNATIVE LI REPLACEMENT W,-'DESTRUCTION aen' INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: I-T) ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE./MFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE f1 ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE R ❑ SUMPS NVlll'1'll _ Il LI:NGIII fl DEPTH ft DISTANCETDNEAREST WELL -- It FOUNDATION II PROPER IYLINE fl ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ ft DISTANCE.TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R ❑ SEEPAGE PITS WIDTH ft LENGTH R DEPTH tt DISI'AN('E'1'O NEAREST WELL It FOUNDATION It PROPERTY LINE I R 1 HEREBY CERTIFY THATI HAVE PRF,PARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE:NOTICE:REQUIRED FOR INSPECT -PLEASE('AIJ.(209)953-7697 S: SIGN11 —cA�(1 TITLE AAjAk DATE LEW,0'a I� Q N O AneH! E VI O HEALT11 4. i r G APARTMENT SE( .'Ll' -1 ppiication Accepted By Date Area Employee ID# Final Inspection By t «- Date 1:1SPECIAL PERMIT-Approved by Character of Soil to De h of 3 Ft: Pit/Sump Soil Character: COMMENTS G /x'07/ — �- PE ESC Received Check Amount Date Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service Re uest# p 7 2- 22.7 g l° /7 0 = 1(, 42-01-001 ONSITE WASTEWATER PERMIT 12:1'02