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ONSITE VEILL "TEWATER TREATMENT SYSTEM ZMIT <br /> 4 SAN JOAQUIN COUNT ENVIRONMENTAL Ami DEPARTMEM 360E WEBER AVE-3"%voIG-CKTON CA$202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JoBAD,Hum _ O CDY2n Ariimpc, rA19--2,26 <br /> CROBS STREET APN W7—.JLIIT'L PARCELSI'l j,je �JL O <br /> munk <br /> OWNER NAME G PHONE /'1 (jam <br /> OWNER ADDRESS ..Zi W. p=,k .)11(rt ��a to g�7 C TATF/ZIP i rfi i CA/ �'112 I V <br /> CoPnnzA 'OR PHONE <br /> ( CONTRARORADORFSS CITVMATE P <br /> ( LiciaiE ❑C42 UC 36 PpOTHER NUMBER EXPIRATION DATE <br /> LWATERTABLEDEPEH: L I2CJ It GEOCRAPNICALINFORMATION: Coerdinuac, ) Y <br /> PPERCTEST If BUILDINGPERMIT# LAND USE APPLICATIO <br /> TYPE OF WORK: ❑ NEWINEFALLATION ❑ REPmB/ADDRION ❑ ENCINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DERRUCTION <br /> 1R INSTALLATION WILL SERVE: ❑ REMvENCE ❑ COMN...AL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBEROFBEDROOMB: NUMBER OF EMPLOYEES: <br /> ❑ SEPfICTANK TYPE/MFG CAPACDV gal NOFCOMPARTMENTS <br /> V ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISrANCETONEAREST: WELL D FOUNDATION ft PROPERTY LME it <br /> ❑ LIFT STATION SIZE TYPEOFPvMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> L ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCETONEARFST WELL 9 FOUNDATION it PROPERTY LME R <br /> ❑ FILTER RED WIDTH R LENGTH R DEPTH R <br /> OLSTwNC[TO NEARrST WELL R FOUNDATION fl PROPERTY LINE it <br /> `I Cl MOUNDED W1. fl ISNGTM R DEPTH R <br /> DRmANCE TO NEAREST WELL R FOUNDATION R PROPERTY ME R <br /> ❑ SUMPS Wmrx R LENGm R DEPTH R <br /> DISTANCETONEAREST WELL fl FOUNDATION R PROPERTY ME A <br /> ❑ DISPOSAL PONDS W. R LENGTH fl DEPTH it <br /> DISTANCETONGREST WELLft FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER Wam R DEPTH R <br /> DLSTANCETONEARFST WELL ft FOUNDATION R PROPERTY ME R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DOME IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE Lw WS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI M]/4H`OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- LEABECALL ON)W3.7697 L <br /> LS.... rY/ I\ TITLE fO 4 / DATE <br /> F <br /> m <br /> 79 <br /> (3 <br /> SD <br /> Imia 0-- <br /> rL <br /> iD <br /> L awl MA <br /> ENV Elf N�h <br /> SAN <br /> (yOl HFJd7 P R <br /> ` Underwood Road <br /> EPARTINENT U. ONLY j <br /> Appllution Accepted By Date ArreE I2 Employa.ID# 53(FG qe <br /> Final inspection BY D.I. ❑ SPECIAL PERMIT-Approved by <br /> Charxur of Shc a DePl6 ofl Fe PI#Somp Soil Character: <br /> COMMENTS PpPCPQ 11 6aArer�C ,{'P95 a44 ! r1/soL p-, iPU Ar4aV2 rA 9Szzn <br /> h _ <br /> L <br /> PE SC Received CBnRN/ Am. PerndU <br /> Code Ixro <br /> BY <br /> RemisedData ServkeR vMtN lavokep PerM1Iq <br /> F v-zz sar 7� /Siy i��.u,� zGc 5 oraras8 <br /> ` .242-001 ONSITE WASTEWATER PERMIT <br /> I2lJ21J003 <br />