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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SDS92 <ID� <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DF.PARTMF.NT <br /> 304 E WEBER AVE-3"°FL-Sl'OCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLEPE//RMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> �I��� <br /> JOB ADDRESS SITS'/ZIP <br /> CROSS S.BEETz's__- _ > <br /> APN (DQ'_ 7 -Q 3 PA RC EL SIZE <br /> ON'NF.R NAME �htiLl ej< ��(��i_- p� l/- < PHONE <br /> J <br /> OWNER ADDRESS ,'`eP _1/ CITY/STATE/ZIP <br /> k <br /> CONTRACTOR l e` e r` Tric PH—E 20�t_9147 1-314S' <br /> CONTRACT OR ADDRESS202-s- CITY/STATE/ZIP Stk ,,; •SFy�s <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER ERPIRATION DATE <br /> WATER TABLEDEPTH:_ it ft GEOGRAPHICAL INFORMATION: Coordinates X y <br /> FW-1ERC TEST(S) NUL <br /> MBER __ LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION O REPAIR/ADDITION ❑ ENGINEER DiSIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT __ ❑ DESTRUCTION <br /> INSTALLATION WILL.SERVE: ❑ RESIDENCE ❑ CO.MMF.RCIAL ❑ OTHER_ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG _ CAPACITY gal NOF COMPARTM ENTS 6' <br /> ' <br /> LI GREASE TRAP TYPE/MFG _ CAPACITY gal <br /> #OF COMPAR'TM ENTS � (� <br /> ❑ PKG TX PLANT DISTANCE TO NEARGST: WELL._ ft FOUNDATLON R PROPERTY LINE It o <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED StSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES _ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH 11 DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH D LENGTH ft DEPTH (I <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R _ <br /> ❑ SUMPS WIDTH ft LENGTH it DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH fl DEPTH D <br /> DISTANCE TO NEAREST WELL ft FOUNDATION B PROPERTY LINE _ft <br /> ❑ SEEPAGE PITS WIDTH fl LENGTH Fl DEPIK ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK.WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI. HOIiR ADVANCE NOTICE REQUIRED FOR INSPEECCTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED �_ TITLE <br /> 1f� 5,1eirer DATE <br /> A � <br /> sAf JC AQ IN O <br /> DEPARTMENT US OVL <br /> Application Ac epled ate �Z Area Employee ID#- <br /> -� Ir Dale��Y/6�o7�Ci 1] SPECIAL PERMIT-Approved by <br /> Final lnspeetio By_ 7 � -� <br /> Character of Soil Nep h 33 Pit/Sump Soil Character: <br /> COMMEN /�` of�S/ �� 01/ `/ �iqt �r 0 �_— <br /> PE SC Received Check#/ Amount Date Permit! Invoice# Permit ID# <br /> By Code INFO B as Remitted Service Request# <br /> �3 l i 0 S k on C4 0(o 0 (0 <br />