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ONSITE WASTEVj. ,,ER TREATMENT SYSTEM ,PMIT <br /> )UIN COUNTY ENVIRONMFNTAL HEALTH DEPARTMENT 304 E WEBER AVE -3""F�TOCKTON CA 95202 - (209)468-3420 <br /> REFUNDABLE <br /> //PERMIT CALL(209)953-7697 FOR INSPECTIONS {EXPIRES I YEAR FROM DATE ISSUED Z, <br /> .1� 1 LQ 6A/z4i64.13 ( po — CITY/ZIT' <br /> DDRF,SS J p '. 1 /+ ,�}/_ V <br /> "r'',�,LL`-1 I�D L(�`�/`' /`"J APN a/�y b� PARCEL SIZE °c <br /> SS STREET ` z <br /> NER NAME F2A4z /r ;i5;�;AAU, PHONE <br /> S�1� O�4itr �1 �i�yo3 <br /> V 1�-� P�j W� CITY/STATE/ZIP <br /> VER ADDRESS �44''�/�r/s� <br /> (TRACTOR {/f `mac.' 1401- PIIOONE ✓�Y�dv� �3 <br /> O i7}C Z( CITY/STATE,/ZIP L"0 1) <br /> 4TRACTOR ADDRESS IJJC <br /> NUMBER _ EXPIRATION DATE <br /> elvse L1 C-42 LJ C-36 OTHER Y <br /> �'ERTABLEDEPTH: ftGEOGRAPHIC'ALINFORMATION: Coordinates X <br /> PERC TEST(S) NUMBER /(�� LAND USE APPLICATION# Poo, - <br /> ❑ REPAIR/ADDITION LJ ENGINEER DESIGNED/ALTERNATIVE <br /> PE OF WORK: Ll NEW INSTALLATION ❑ DESTRUCTION <br /> ❑ REPLACEMENT <br /> SPALLATION WILL SERVE: ❑ RE;SIDE;NCE: <br /> ❑ COMMERCIAL r()'I'IILR <br /> NUMBER OF LIVING UNI'T'S: <br /> NuNIIIER OF BEDROOMS: UMBER of EMPLOYEES: <br /> i SEPTIC TANK TYPE/MFG_ - <br /> CAPACITY gal #OF COMPARTMENTS <br /> TvrE/Mr•G <br /> GREASE TRAP -- <br /> CAPAC - I #OF COMPARTMENTS <br /> J PKG TX PLANT DIST'ANCE,ro NEAREST: WEI.I. __ <br /> It I'OIINI 10 Il I'ItOPIfRTY LINE ft <br /> J LIFT STATION SIZE: TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ] LEACH LINES ❑ LEACHING CHAMBERS <br /> #OF LINES LENG]11 OF LINE'S ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE <br /> R <br /> tt ft <br /> ❑ FILTER RED WID'T'H DFrrn It LENGTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION 11 PROPERTY LINE <br /> ❑ MOUNDED Wm1 11 It LENGTH <br /> 1l DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ tl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH ft DFPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I"AVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE:WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> SPATE:LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 ADVANCE NOTICE RE;QUIRED FOR INSPkCTIONS-�Pt ESE CALL(209)953.7697 <br /> SIGNED <br /> TITLE 1 "� DATE 7 <br /> j� <br /> j ,CLIU <br /> 11\ 'AJLLtL <br /> I F- <br /> n, <br /> 10 <br /> S N O U N OU <br /> DEPARTMENT ll E ONLY L4 1 <br /> Application A�oj <br /> te y -> —�� -,,Date L- Area r � Employee ID# �? / <br /> Final Inspecty Dat( ❑ SPECIAL PERMIT-Approved by <br /> Character ofo Dep of3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> �i <br /> c7` ' <br /> PE SC Received eck# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> ( \I \ \ <br /> 11 <br /> Ila <br /> 2-01-001 <br /> 202 ONSITE WASTEWATER PERMIT <br />