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ONSITE WASTEWA�.R TREATMENT SYSTEM PERM[1l �� <br /> SAN JOAQVIN COUNr\'ENVIRONM1tENTAL HEAI.I'II DEPARTTIENT 304 E WEBER AVE-3"'FL-S FOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 20 953-7697 POR INSPECTIONS XPIRES 1 YEAR FROII DATE ISSUED <br /> Jon ADDRESS Com- L` CT'/ZR O <br /> a <br /> /f � �I ` M <br /> CROSS STREET —Jn A-,lts"S //�)Y APN —zrye —®� PA RCEL SIZE ` p <br /> O1YNE0.NAME \I r P�H/O�NFE�, <br /> OWKrRARRRESS J/J I / r`. CITYISTATE/ZIP �j�GCL�V <br /> COSTRALTOR .0 /Y PH /ONE / 1z1s ' <br /> CONTRACTDR ADDRESS CITY/STATE/ZIP 73 Ksu <br /> ^ LICENSE -42 ❑ -J OTHER NUMBER EXPIRATIONDATE (� <br /> WATERTARLEDEPTH: R GEOGRAPHICALINPOEaArto : Coordinala X Y <br /> ❑ PERC TEST N BUILDING PER LAND USE APPLICATION IF 1T�� <br /> TYPE OF WORK: ❑ NEWINSTALLATION REPAtWADDrr1ON ❑ ENGINEER DESIGNED/ALTERNATIVE I`l <br /> ❑ REPLAcv,uN ❑ DE VMON 1 <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS[ / NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal N OF COMPARTMENTS ^ <br /> ❑ CREASE TRAP TYPE/MFO CAPACITY gel N OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISPANCETONEAREST: WELL ft FOUNDATION. ft PROPERTY LME R IUM <br /> ZAI LIFTSTATION SIZE_ TvPEOFPUMP13 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> p 'I LLL t11�Ja1' <br /> yon LEACH LINES K LEACHING CHAMBERS NOFLINES_./— LENGTH oFLMFs ^ ft <br /> DISTANCE TO NEAREST WELL 00 R FOUNDATIONR PROPERTY LINE �C/ R <br /> ^ ❑ FILTER RED WmTH R LENGTH R DEPTH R <br /> DISI'ANCETONEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH fl LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH-11 LENGTH ft DEPTH R <br /> DWEANCETONEAREST WELL fl FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS W."-ft LHGTH ft DEPTH fl <br /> DISTANCETONE REST WELL R FOUNDATION ft PROPERTY LIKE R <br /> SEEPAGE PITS NUMaeRN9nTx fl DEPTH r-.L- y A <br /> DISFANCETO NEAREST WELL ft FOUNDATION it PROPERNLINE J n fl <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS ANO RULES AND REGULATIONS OP SAN JOAQUIN COUNTY. <br /> t" MIN M 2d H R AD ANCE NOwO,TTs CE UIRED FOR INSPECT NS-PLEASE ULT.(200)053 7697 <br /> SIGNED l -+SA ITLE DATE <br /> J A I <br /> DEPARTMENT HE O V <br /> Applleallon Accepted DRte �� Area Employee lON T -L <br /> Final lnapectioBy Date �G 11SPECIAL ERMIT-Approved by <br /> Charottet Df Snll to Dj Ihaf3 Fl: PiVSump Soil Chander:_ <br /> COMMENTS <br /> PE SC Received Chttkpl Amoum Perm1V <br /> Code INFO IIa4 Remitted Data Sen4ce Re uesl InvoldeN PermH IDN <br /> IIS4 p U- <br /> 42-02MI ONSITE WASTEWATER PERMIT <br />