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ONSITE WASTEWAI..rTREATMENT SYSTEM PERMIT `1 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3m FL-STOCETON CA 95202 -(209)46&3420 <br /> NON-REFUNDA <br /> BL <br /> E <br /> PERMIT E. CALL 209 953-7697 FOR-eINSPECTIONS EXPIRES 1 YEARFROMDATE ISSUED <br /> JOBADDRESS .nn ��• L U LI\FY�YI�(rv� �C Cfli� / �5� �Je eC�ITY/ZIP-/ `"LC i i.✓1 OYA <br /> CROSSSTREeI' 1��C� ,YY'�Y.� 0c,,'O1 APN �-%��� rY _r-� 1,�v 1 '�Z PARCELS.. <br /> X <br /> OWNER NAME 7 +"! InI, lrk'•b\Ci(,L,I `I� LIQ. �1� I {�lY' LIIr L�(1%I/`\�I PNONE 4kG-- 7407 <br /> 7 <br /> OWNERADINESS 1� 1"- //1 "C�' !� '7 CM/SFATFJZIP (^-/G �fL I`, Pah <br /> IMP CONTRACTOR C_`. <br /> �I. I PHONE <br /> .•�'e/{,f [' ,� , II')r <br /> CONTRACPORADDRESS ,' '+I Llf CITY/STATE/ZIP <br /> i <br /> LICENSE Ll C42 13 C-36 OTHER NUMBER EXPIEATIONDATE <br /> Ba WATER TABLE DEPTH: � �" ft GEOGRAPHICALINFORMATION: CooTlnatd X Y <br /> ❑ PERCTEST BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION CI REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIYE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: ❑ RESIOERCE Cl COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBEROF BEDROOMS: NUMBER OFEMPLOYEES: <br /> ❑ SEPTICTANK TYPFIMFc CAPACITY Eel k OF COMPARTMENTS <br /> y ❑ GREASE TRAP TYPE/MFO CAPACITY gal k OF COMPARTMENTS <br /> ❑ PKG TX PLANT DIRPANCETONEARERnG WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ LIFTSTATION SVL TYPEOFPUMe ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEM) <br /> 'B" ❑ LEACH LINES ❑ LEACHING CHAMBERS kOFLNES LENGTH OFLINER ft <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LME R UJ <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It c <br /> DWANCETONEARTSI' WELL ft FOUNDATION ft PROPERTY LNE R <br /> RR` ❑ MOUNDED WIDTN ft LENGTH R DEPTH R C' <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LNE R <br /> ❑ SUMPS W. ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LNE R NI <br /> r ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LNE R 1 <br /> ❑ SEEPAGE PITS Numasa WDJTH It DEPTH ft ! <br /> DHmANCETONEAREST WELL R FOUNDATION R PROPERTYLNE ft <br /> I HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE EGUL WILL BEDONE ACCORDANCE WITH SAN JOAQVIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY: <br /> ''SMI/NIM'❑\M�HeNOVR nDVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20)9534697 f/ <br /> Bl+ SIGNED6 TITLE (�' l�l..� 1` DATE <br /> 1 I <br /> 7' L lJq. <br /> v <br /> .-e. i <br /> 3 y <br /> �1 l <br /> h'�"�y �7. . EMN O •.' UN <br /> Ir <br /> DEPARTNILS I USF ONLY' <br /> ❑ SPECIAL PERNIII-\ el Uy <br /> cl TaTe [sml to uTPro r3 FI:. _ PLaI mFS lch.,. ,,:- <br /> �PE SC R ✓ - Amur P 6uestk <br /> I v es Pe,mlt lDk.. <br /> Catle Into B:. CesM1 ry Re Itted Det 6cRe <br /> 9 _ `l <br /> i <br /> e > _ -. •.- . o��+r 'e_.a,. a -rit e-r. -vv-;r •r-,.. �e.i, OM1'SITE WASTEWATER Y£N1P.T <br />