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ONSITE WASTvWATER TREATMENT SYSTEM PER'"T <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH GMENT '\ 304EWEBERAVE-3° FL-SI,aaWONCA95202 - (209)468-3420 <br /> iaaas NON-REFUNDABLE PERMIT y ALL(209)953-7697 FOR INSPECTIONS EXPIRES.I YEAR FROM DATE ISSUED <br /> JOB ADDRESS LI Ww J "LT,1 R 1P1r,�1 CITY/ZIP ca4'V1pc •U'226 y <br /> CROSS STREET „'I'to �( G� /rlP f' All "" I- CJ PARCELSIZE I�'��❑L e <br /> r OWNER NAME Y' (1"_ ��I{wac I v`�� PHONE <br /> OWNERADDRESS r.6 `� V�1r/�I ` !r CITY/STATE/ZIP F-Glu"I CA 15M <br /> 1 U <br /> CONTRACTOR 0 T V`�����• ` ' - C I C'r - I PHONE /�I �/t/-�I�//� <br /> CONTRSCTOR ADDRESS ZP In. J�y_; L '::F�QfIY(ST'{XvZIP. `E(A' -... 152 <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER) EXPIRATION DATE AJ' <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y O <br /> ra PERCTEST(S) NUMBER LAND USE APPLICATION# U <br /> TVPEOFWORK: ❑ NEW I NSTALLATION ❑ REPAIWADDITION ❑ ENCINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INBTALLATION-WILLSERVE: ❑ RESIDENCE ❑ COMMERCIAL _ ❑ OTHER <br /> NUMBER OF LIVING UNI TS: NUMBER OF BEDROOMS: NUMBER OFEMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPUMFG CAPACITY gal #OF COMPARTMENTS <br /> _ ❑ PKG TX PLANT DISTANCETONEAREST: WELL B FOUNDATION it PROPERTY LINE. It. <br /> ❑ LIFT.STATIONSIZE Twe OFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ..;.�" <br /> ❑ LEACH LINES O LEACHING CHAMBERS #OFLTNES LENGTH OFLINES ft 1 <br /> DISTANCE TO NEAREST WELL - ft FOUNDATION - ft PROPERTYLINE fl <br /> ❑ FILTER BED WIDTH R LENGTH -R DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION _ R PROPERTY LINE IT <br /> ❑� MOUNDED WIDTH _ IT LENGTH' - it DEPTH R <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ^, <br /> ❑ SUMPS WIDTH R '..LENGTH IT DEPTH y. R ' <br /> DISTANCETO NEAREST WELL ♦♦' R FOUNDATION ft PROPERTY LINE ft <br /> ❑- 'DISPOSAI:PONUS TV.. Y:..�., .. ..ft.Y'•gL"ENG "'i *` "'P '" ';N. Rfrs'Yh$F.� <br /> DISTANCETONEAREST WELL ft FOUNDATION fl PROPERTY LINE it r(,. <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH R DEPTH - ft <br /> DISTANCE TO NEAREST WELL "fl FOUNDATION ft PROPERTY LINE R <br /> THEREBY 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 /> 1NIMUM 34 HOUR ADVANCE NOTICE REQUIREDFONINSP O\$�(L)�SF.C'ALL R09)9S D-7697 <br /> ATE �{/(/'��' <br /> SIGNED (// TITLE U/ �J <br /> lI <br /> 1 L 6 <br /> h <br /> L �. <br /> i <br /> ` 1 We_ I p UI <br /> 4J <br /> NT <br /> x=„ DEPARTAI/f�f2�ll�011DSV 2f 5�N Ie f <br /> / j oo <br /> Application Accepted By Date Area T Employee ID# 95 <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by - <br /> Character of Soil to Depth of 3 Ft: PIUSUmp 5011 Character: <br /> .COMMENTS <br /> iA <br /> PE SC / Received Amount Date Pe to <br /> InvDice# - Permit lDq <br /> Code INFO/ B Cash w Remitted Service Re uert p <br /> kuuyo / " <br /> _ 42-01-00I " ONSITE WASTEWATER PERMIT <br /> 13202 <br />