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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE 3M FL-SEN'JRON CA 95202-(209)468-3620 <br /> NON-REFUNDABLE PERMIT CALL n(2209)953-7697 FOR NSPECFIONS EXPIRES 1 YEAR PROM DATE ISSUED <br /> Jos ADDRESS - L 1 T"V CI'rvZP Oiy <br /> A <br /> CROSS STREET APN Z g I i G ✓ 1 s 17j P 1RCEL$HE Z✓�+ O <br /> r OWNERNAME I� 4�{n I PHONE Cl Ci T/ <br /> 1\. <br /> Z - , F[C� <br /> 4TEMPOWERAODRFSB LW 1 / n C.. �1`� S✓'-1� <br /> CONTRACTOR PHONE <br /> �w COHTMCTOR ADDRESS CITY/STAITJZIP <br /> LICENSE 0 C4 OC-36 OTHER NUMBER ExpvtAmON DATE <br /> WATERTABLEDEPTN: R GEOGRAPHICALINPoRMATION: C00rdlnatee K Y <br /> PERE TEST k D BUILDING PERMIT# LAND USE APPLICATION#\J a'Yn .ne c <br /> h� <br /> TYPE OF WORK: ❑ - NEW INRI'ALLATION ❑ REPAIRIAOOTHON ❑ ENGIXEER DE61GNE0/ALELI4YATIVE <br /> ❑ REPLACEMENT ❑ DDErhu IION <br /> INSTALLATION WILL$SKYE: LJ RESIDENCE L3 COMMERCIAL ❑ O'1'l1ER <br /> NUMBED LIVINOUNIT!E NUMNEROFBEDROOME: NUMSEROFEM%gYEES: <br /> ❑ SEPTICTANK IYPHMFG CAPACT' 891 00FCOMPARTMENFS <br /> ❑ GREASE TRAP TYPEJMEG CAPACITY Set 00FCOMPARTMENTS <br /> ❑ PEG TX PLANT- DIEMNCETONEARin': WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ LIFT STATION- SIZE _ TYPEOFPUMP - ❑ SANDOILSEPARATOR(ENCIASF.DSYMEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OPLN65 LENGTHOFLINE6 R <br /> DISTANCE TO NEAREST WELL. R FOUNDATION ft PROPERTY LINE fl <br /> IRR, ❑ FILTER BED WIDTH fl LENGTH It DEPTH R <br /> DISTANCETONEAREET WELL It"FOUNDATION A PROPERTY LEIS R 3 <br /> ❑ MOUNDED WIDTH fl LENGTH ft DEPTH R ' <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LNE R RT <br /> ❑ SUMPS Wmix R LENGTH ft DEPTH fl <br /> DISTANCE iO NEAREST WELL R FOUNDATION R PROPERTY LNE R <br /> ❑ DISPOSAL PONDS Wmix ft LENGTH R- - DEPTH ft r <br /> T <br /> DISTANCE TO NEAREST. WELL IT FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER Wmix ft DEPTH ft 1\ <br /> _ DISTANCETONEAREST WELL It FOUNDATION R PROPERTY LME R m <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES ANO REGULATIONS OF SAN JOAQUIN COUNTY. - - <br /> B� SIGNED MINIMUM 14 H0 ADVCNCJE4NOT`IC`RPQWRED RINBPECTIONB PLEASECALL(20)953-7697 <br /> TITLE <br /> (,-,—C 'l <br /> 1rP <br /> I <br /> ni M <br /> H. <br /> U/ <br /> 41. <br /> ` R u <br /> 4RRDEPARTMENTUIYE ONLY ''// .S <br /> Application Aeeepted By 1 ` .Dale 9-1�L Dr ALTA EmPloy.1m 4&o <br /> Final lnrpxtH.By Date ❑ SPECIAL PERMIT-Approved by , <br /> Chameter of Sail to Depth 9f 3 Pt: PIVSump Soil Character: <br /> IB. COMMENTS <br /> PESC. Re WRI Chea Amount Date PSTRIV InwlmB PerMllp9 <br /> L Code ixw B Reh RemlNed SmiaR ueHN <br /> 42.=� Sz NL (= ti dl3 46Scor� u> 'A'<( 40' <br /> @ 02-0DDI ... ONSHE WASTEWATER PERMIT <br /> ILLErzWI <br />