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IL)"� o <br /> ONSITE W `'EWATER TREATMENT SYSTEM P� VIIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEA'P"EPARTMENT 304 E WEBER AVE-3"FL's WOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE rPERMIT !� CALL(209)953-7697 FOR INSPECTIONS <EXPI,RE.SS11 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP p,vL�f—1 mV R <br /> CROSSSTREET _ 11 ^^Nyllnk V:,!nj yr�LAPN IC-2-150'(.- PARCEL SIZE p 7 pa <br /> OWNER NAME PHONE <br /> OWNERADDRESS � <br /> CITY/STATE/ZIP 2�q Com/ <br /> a CONTRACTOR t)ADa- cXJt' I -+-y d✓F�-l�F...S�,v�9r -ill..• PHONE ✓VLZ L'��J[i <br /> CONTRACTOR ADDRESS I-S'j I 0. AV 6. CITY/STATE/ZIP cj <br /> LICENSE I-C42 ❑C-36 OTHER NUMBER EXPIRATION DATE OZ 2.13 O <br /> f WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# —Q.30c� 5 LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 3 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: /^1,,��,,�`'^' I t NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: -�- <br /> kI SEPTIC TANK TYPE/MFG V �` ��L CAPACITY r r(C)0-0 gal #OF COMPARTMENTS -2- <br /> L1 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> L3 PKC TX PLANT DISTANCE TO NEAREST: WELL z0C) ft FOUNDATION (0,51 ft PROPERTY LME I ft <br /> ❑ LIFT STATION SIZE TYPELLO,FF, PUMP 2 C3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> E3ba-z LEACH LINES W LEACHING CHAMBERS ' 0- ,J(O #OF LINES -3 LENGTH OF LINES 100, ft <br /> DISTANCE TO NEAREST WELL LOO' ft FOUNDATION 00' ft PROPERTY LINE f60r ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R -� <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTHft (T <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft (� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ll: <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY 1Y1 <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ��,/A�1INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 �[ <br /> SIGNED TITLE [PDATE <br /> N O 1 <br /> 2 <br /> 0011 <br /> O I <br /> r <br /> � E <br /> S N O <br /> Aj ITNE <br /> v <br /> _ DEPARTMENT U§E ONLV <br /> Application Accepted By Date 7-9- V' Area oZ/tl.J Employee IDN <br /> Final Inspection By v Date y ❑ SPECIAL PERMIT-Approved by 7 <br /> Character of Soil to D th of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS 3 $r)rL M I-f PE 41-t {�-tr.0 <br /> .� PE SC Received Check#/ Amount Dale Permit/ Invoice# Permit ID# <br /> Code INFO By as Remitted Service Request# <br /> 2-13 1/-7 �t�a D MO `f D 37 g l b <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />