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SAN JOAOUIN COUNTY ENVIRONMENTAL WASTEWATER TREATMENT SYSTEM EMPERMoT <br /> cABszos-(20B>aYe-aozDBszos-(20B>aYe-aozD <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 5577N. _ <br /> s <br /> DmZP ToCJi7°+J v, <br /> CROSSSTREET L:N EtDI:Et: (Wn0 APNa7—/O 2--4' <br /> �ft<j`Y PARCEL SGE _ C <br /> OWNER NANE_ LAbn.f 'Ts1 PHONE <br /> OWNEfl ADORES�B.`.GSAI''�4A '({'( <br /> S 5^J�J A/ .UImSTa <br /> ` , <br /> CONTRACTORy❑ I-4i�5Y l3^r-KFb4 1NL PHONE ` -54,- -F}4Wq y_ <br /> CONTRACTORADDRESS 33 "y'Jolk _ _______......... elrrsuTEZP_ Lab-:[- CA 0% Z.4 J <br /> J <br /> LICENSE ❑':-'C42 ❑.C-36 OTHER r,\ NUMBER 05��1tXPIRATION DATE <br /> I U <br /> WATER TABLE DEPTH:I Q R GEOGRAPHICALINFORMATRNI: Coord atea X Y 1 <br /> Il PERC TEST Y BUILDING PERMR LAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION EPAIWADDUION ENGINEER DESIGNED/ALTERNAYWE <br /> REPLACEMENT OUT-OFSERVICESEPTCSYSTEM DESTRUCTION l5f <br /> INSTALLA710NWILLSERVE: 011,RESIDENCE ii COMMERCIAL ❑ OTHER L <br /> rv- NUMBER OF LWMG UNITS: NUMBER OF BEDROOMS: NUMBEROFEWLOYEES: L <br /> p SEPTICTANK TYPEIMFG P+►. CAPACITY \boJ Sal MOF CDMPARTMENT$ Z 7 <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY o <br /> Sal #OFCOMPARTMEWS D <br /> DSTANCETONEAREST: WELL____ R FOUNDATION__,_ .. R PROPERTY LINE R V <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP__ _ O PRO TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES XLEACHING CHAMBERS Iroit(tWA�AT YOFLINES <br /> _ __ LENGTHOFLINES 60 it <br /> DISTANCE TO NEAREST WELL 10(3 R FOUNDATION 2-'�' it PROPERTY LINE S ry <br /> ❑ FILTER BED WIDTH It LENGTH_ _ R DEPTH it <br /> DISTANCE TO NEAREST WELLR FCtINOATION it PROPERTYUNE it <br /> ❑ MOUNDED WIDTH it LENGTH---_ft DEPTH ry <br /> DISTANCE TO NEAREST WELL _ it FCAINDAT,cW it PROPERTY UNE it <br /> ❑ SUMPS WIDTH—It LENGTH______ R DEPTH D <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTYLINE it <br /> ❑ DISPOSAL PONDS WIDTH—ft LENGTH ry DEPTH n <br /> r�, DISTANCE To NEAREST WELL____..__ it FOUNDATION k PROPERTY UNE h <br /> `fes SEEPAGE PRS NUMBER 11 WIDTH �47," R DEPTH 7S I ry <br /> DSTANCETONEAREST WELL A6O�— R FWNOATION R PACPERTYUNE WI'sit <br /> I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WALL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES ANO REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL/209)953-769 <br /> SIGNED _ — TITLE 'ilCES1Q GNI DATE <br /> J <br /> I n <br /> ull <br /> EP <br /> DEPARTMENT 12 P AA2 N If �./� <br /> Application Accepts - Date Area Employee ID#IF I r <br /> Final Inspection By - Dats U SPE IAL PERMIT-Approved by <br /> Character of Soli to pth o/3 Ft: Pitt ump Soil Character: <br /> COMMENTS CLr <br /> PE SC Relived CheckY/ Amount Date Perm1U mvoksY Parmlt lDY <br /> Coda INFO B Cash Remitted Service U.,Y <br /> 13fli ILI, IStZUO <br /> I <br /> 62-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> M 4112 <br />