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TON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS <br /> EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS t,J � �. CITY/Z[P__f' <br /> CROSSSTREET !� `�.✓� j��-t�4 ++�� �} f <br /> ---�, APN_ 2C 7—(' - �/ PARCEL SIZE �. <br /> OWNER NAME yp ,R <br /> PHONE 20 1 9 2 S l <br /> OWNER ADDRESS / Cy CITY/STATE/ZIP.Si-6 c- d L" <br /> CONTRACTOR <br /> PHONE <br /> CONTRACTOR ADDRESS r CITY/STATE/ZIP <br /> 1-' <br /> LICENSE ❑C-42 ❑C-36 �Or H S� NUMBER <br /> EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORM Coordinates <br /> X y ` <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# LI <br /> TYPE OF WORK: Id NEW INSTALLATION ❑ REPAIR/ADDITION <br /> ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> El <br /> d DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL <br /> 4 ❑ OTHER f� <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS; �- <br /> `3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE:/MFG-Pre -K(AS+ [n 11 cref CAPACITY <br /> gal #OF COMPARTMENTS <br /> C] CREASE TRAP TYPE/MFG CAPACITY <br /> gal #OFCOMPARTMENTS , <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION <br /> ft PROPERTY LINE ft / <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) iV <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS <br /> !#OF LINES 3 9t�LENGTH OF LINES T O ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Q t3 <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH e <br /> ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE C3 MOUNDED WIDTH ft <br /> ft LENGTH �ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> El sumps WIDTH ft <br /> ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 3 1) ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTHtt <br /> ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH <br /> III <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 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 /> INI M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE lid DATE -Q <br /> ex an <br /> is <br /> ----------- <br /> ------------ <br /> . r <br /> A <br /> r <br /> i <br /> c � <br /> r <br /> DEPARTMENT PSE ONLY <br /> Application Accepted Date �/ /7/0-,l Area 2- 11 Employee[D# 0e cS 1 <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soi[to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS v <« .4e a 4 /--_44Ct '52, .re, <br /> old to-I< <br /> PE SCReceived hec Amount Permit/ <br /> Code INFO By Cash Remitted Date Service Request Invoice# Permit ID# <br /> # <br /> 42-01-001 <br /> 12!2102 ONSITE WASTEWATER PERMIT <br />