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ONSITE`' STEWATER TREATMENT SYSTEM" 'RMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HIS tl DEPARTMENT 304 E WEBER AVE.-3 , 1ST(X'1:TON CA 95202 -(2(19)468-3420 NON-REFUNDABLE PERMIT ,t CALL(20�9)p953-7697 FOR INSPECTIONS �jEXPIRES 1 YEAR FROM DATE ISSUED JOBADDRESS ll��1 i��T'�HL J L�Lv� CITV/ZIP_R/PV/V CROSS STREET Aa51—{/�+�`/�tyV,«L/h� rte` _ APNOM"G'5 PPAARC'ELSIZE r2//� �S OWNERNAMF. [�(0 01 i9p J T-/C— ,PHONF}.�Gp,.7�-y�� 4L( 5 OWNER ADDRESS P-® 13nsc 79,� CITY/STATE/ZIPI-�OIJC�j / (/ �5 53 CONTRACTOR PHONE 8-403 i (�''/-��/r♦�y ("{//yJ�µL��Cl /f CONTRACTOR ADDRESS / O g2(�1}t d Ra` _ CrTY/STATFJZIP J"r-L-VN- LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATT ABLE DEPTH: fl GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST(S) NUMBER _ LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGI NEER DESIGN ED/ALTERNATIVE. ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER _ NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEJMFG CAPACITY gal #OF COM PARTMFNTS ❑ GREASE TRAP TYPE/MFO CAPACITY gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE tl ❑ LIFT STATION SIZE_ TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R DISTANCETO NEAREST WELL ft FOUNDATION t1 PROPERTY LINE fl ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft DISTANCE TO NEAREST WELL Il FOUNDATION It PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R '� ❑ SUMPS WIDTH ft LENGTH fl DEP-1-H ft DIS'FANCETONEAREST WELL fl FOUNDATION R PROPERTY LINE t1 O DISPOSAL PONDS WIDTH 11 LENGTH R DEPTH tl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE. ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH tl DIS"LANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r 1 HEREBY CERTI�)rHA7 I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE,1N ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, r STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. r M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED `� TITLE DATE_ Ty 1;7 VC 0 7 N ti 1) 1 _ DEPARTMENT USE ONLY O Application Accepted By �. Dale_ -w2-// Area �� Employee ID# 9 Final InspeetbnBy Dale ❑ SPECIAL PERMIT-.Approved by Character of Soil to of I: Pi Sump Soil Character: COMMENTS PE SC Received Check#/ Amount Data Permit/Code PermitlD# Code INFO tl / Remitted " 27L .52--) 1p 7..� tits t' zwC) I 42-01-001 12/1/02 ONSITE WASTEWATER PERMIT