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L !:r <br /> ONSITE.WA ATER TREATMEN <br /> T SYSTEM PERnyy <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL,HEALTH[MEN7 ,304EV5`E6ER AVE-3 'FL-$TOt� ��I CA 95202 -(209)46$-3420 <br /> NON-REFUNDABLE PERMIT BALL(209)953-7697 FOR INSPECY1015 EXPIRES 1 YEAR:FROM DATE ISSUED <br /> JOS ADUHF155I v'v All, CITY/LIP 11,6A 11"{'-LL <br /> 11��,..�1,, <br /> CROSS�STRBET -1 a�'e�; �.�F'i'> I 'V ! ��DU/ 1 I If C_ <br /> { APN PARCEL SIZE <br /> OWNER NAME , hli. �vc:ti"� - <br /> /PHONE <br /> OWNER ADDRESSf! LI ?' J:14 f. i�.4. - f?4r,✓�L,�I. LY.; / -f7 1 C <br /> ' C171'ISTATE:IZEP <br /> t - <br /> CONTRACTOR �L I J✓1 11;'L'-.t.r[..P I'1{I:t i 1 t�'' <br /> PHONE <br /> CONTRACTOR ADDCITY'/STATEIZIP i-J. <br /> • I{.et f `i-z L/ <br /> - <br /> LICENSE , ❑C-42 ❑C-36 OTHER t' '- NUMBER {I' EXPIRATION DATE •I 1 /l <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates- 'X _., -_r y - <br /> PERC TEST(S) NUMBER LAND USE APPLICATION# _? I <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENCIN'EER DESIGNED{ALTERNATIVE <br /> jjj{f�kJJ�J ❑ REPLACEMENT ❑ DESTRUCTION <br /> F� <br /> INSTALLATION WILL SERVE., ❑ RESIDENCE- ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROFLIVINGUNITS: NUMBER OF BEDROOMS: -NUMBER OF ERIPLOYEE.S: - <br /> /�5 ❑ SEPT IC TANK TYPE/MPG CAPACITYgal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> L) PKC TX PLANT DISTANCE TO NEAREST: WELL €t FOUNDATION R PROPERTY LINE ft <br /> ❑ LIFT STATIONSIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSFD SYSTEM) <br /> ❑ LEACII LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF Lwes <br /> DISTANCE TO NEAREST ,WELL R FOUNDATION fl PROPERTY LINE 0 <br /> ❑ Ft LTER RED WIDTH fl LENGTH A DEPTH ft <br /> Dmi-ANCETONEAREST WELL R FOUNUATION _ fl PROPERTY LINE -0 _ <br /> - ❑ MOUNDED WlDrll ft LENGTH ft DEPTH - FY <br /> Dt5'rANCETONEAREST WELL 1k FOUNDATION fi PROPERTY UNE fl <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST, W£LL - ft FOUNDATION . ft PROPERTY LINE ft <br /> ' ❑ DISPOSAL PONDS WmTll ft LENGTH - R DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft .PROPERTY LINE -ft <br /> ❑ SEEPAGE PITS WIDTH It LENGTH - - R DEPTH' fF - <br /> DISI'ANCETONEAREST WELL - ft FOUNDATION R - PROPERTY LINF, It _ <br /> I NEREEY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, i <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M <br /> F - GA' ( y24RMOUR'•ADVANCE NOTICE REQUIRED_FOR INSPP;E=CTIiO'!.S'f 1 PLEASE-� CALL(.3.0.9.)953 7-69,7 <br /> +YDATESIGNED TITLE 1.r <br /> :I <br /> f -- <br /> LC — — <br /> RMI-36.CF0 <br /> - SEITICft uI:E - <br /> -, 1/o sEcli[N IIHT� <br /> H 5dlbtiflf <br /> r_ <br /> a 1 <br /> b "oEstcRa'r>.v RWAIrIDsR` <br /> - a^o'wcvx 7.n tiO� rr- <br /> h <br /> ager <br /> _ PAACEL"I" w <br /> $ Loo FERES B - <br /> MMM I <br /> z �y ela.+tn _ <br /> 1144i Rsroo+o�•c loom• ��`';1�`� RIJIN11W Ft <br /> )tit ITYfIT f <br /> P <br /> dFJ Ft— <br /> e, <br /> 2i1�.-9:o-V1 - <br /> c/[VG,I.Y�IE J <br /> - ` rY UEPAH'I MLN'1'USE ONLY <br /> ApplicationAccepted By S�� `I�.. -Y`� �-'-Date Area F Employee lD# ✓I f r{ <br /> tom'- Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth o€3 Ft: PitlSlimp Sail Character: - <br /> COMMENTS -4 <br /> 01 <br /> Pk: SC Received heck#r Amount Permi[I <br /> D to - Invoice# Permit lD# <br /> Code NFO .BY,- C asb, a jttcd � r,ServislS,Re uest# <br /> 10 V <br /> r - <br /> I'!. 42-01-00I r - <br /> 12h1[12 ONSITE WASTEWA]ER PERMIT <br /> R <br />