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\'e ONSITE WASTEWATER TREATMENT SYSTEM PERMITcp952a2-(209)468-3420 <br /> SA%N JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR IVSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED ip <br /> CITYIZIP 1f �-��"�� I M <br /> FJOB ADDRESS <br /> // APN C'C S` -'3�C-•-(l: PARCEI.SLZE_- t2 <br /> 4'C e <br /> OSS STREET tLLtl�f 5'y <br /> �^ L� 1)"—AL J <br /> NER NAME <br /> �i�Rta JVYt9l CtJ �+. 4F OY�L�L.PH NE Yi <br /> CITYISTATEIZIP L.o.- ',.. <br /> NERADDRESS <br /> .`. ` PHONE <br /> CONTRACTOR M <br /> CI7Y/STATE/ZtP <br /> CONTRACTOR ADDRESS <br /> NUMBER ExPIRATON DATE <br /> LICENSE C-02 ❑C-36 OTHER Y—_-- <br /> WATERTABLEDEPTR: ft GEOGRAPHICAL INFORMATION: Coorditiates X <br /> ❑ PERC TEST # BUILDING PERMIT i# la'I)-,,DDITI Zd LA YD USE AP❑PLIENCNO[DESIGNED/ALTERNATIVE <br /> TYPE OF WORK: 48' NEW INSTALLATION D RSPAfR/ADD1T10N <br /> ❑ DESTRUCTION <br /> ❑ REPLACEMENT <br /> ❑ COMMERCIAL ❑ OTHER <br /> SNSTALLATIONWILLSERYE: RESIDENCE NUMBER OF EMPLOYEES: <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> CAPACITY 1 6�CCT D Bal #OF COMPARTMENTS L <br /> SEPTIC TANK TYPEIMFG ` ''mss CAPACITY gal #OFCOMPARTME:wTS <br /> ❑ GREASE TRAP TYPFjMFG ft <br /> A FOLNUATION fl PROPERTY LAE <br /> ❑ PKC TX PLANT DISTANCF.TO NEAREST: WELL ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LIFT STATION SIZE TYPE OF PUMP <br /> #Of LFNES /y LENGTH OF LINES ft <br /> Z-LEACH LINES ❑ LEACHING CHAMBERS ' R <br /> It PROPERTY LICE <br /> DISTANCE.TO NEAREST WELL. /CC' •{- It FOUNDATION ft <br /> R LENGTH fl DEPTIS <br /> ❑ FILTER BED WIDTH }t PROPERTY LINE -.--ft ' <br /> DISTAVCETONEAREST WELL fl FOUNDATION <br /> ft LENGTH ft DePTH H v1 <br /> ❑ MOUNDED WIDTH ft PROPERTY LINE tt <br /> DISTANCETONEARESr WELL ft FOUNDATION ft <br /> �l <br /> L3 SUMPS WmTH ft LENGTH ft DEPTHft PROPERTY LINE R - <br /> DISTANCE TONEAREST WELL 1't FOUNDATION <br /> ft DEPTH ft <br /> ❑ DISPOSAL PONDS WHITH ft LENGTH ft PROPERTYLINE—ft rJ <br /> DISTANCE TO VEARESR WELL ft FOUNDATION ft <br /> n WIDTHfl DEPTH ft <br /> , <br /> SEEPAGE PITS NU _ <br /> MBER J <br /> DISTANCE TO AREST w'ELL. 1�L+ ft FOUNDATION <br /> Q PROPERTY LINE <br /> 1 HEREBY CERTIFY THAT 1 HAVE <br /> ORDINANCES`.STATE LAWS AND IRULES AND REGULATIONS OF SAN JOAQUIN COUNTYON AND THE WORK WILL OF.DONE IN ACCORDANCE WITH SAV JOAQUIN COUNTY <br /> \:1NCF:NOTICE RE{?I:I RF FOR INSPECFIONS- t <br /> PLEAS1 �7647 <br /> DATE <br /> TITLE <br /> SIGNED <br /> G <br /> H E A E <br /> � 0 <br /> s <br /> r I <br /> I <br /> � I <br /> t <br /> J- <br /> L <br /> t <br /> % DEPARTMENT USE ONLY <br /> Date 7 Arra Employee IDR r) <br /> Application Accepted By — <br /> Date / 13SPECIAL PERMIT-Approved by <br /> Final Inspection By <br /> harutcr: <br /> Character of Soil to th of 3 Ft: tJSump Soil C _ <br /> COMMENTS n f L_i'i' i c <br /> c.►t <br /> PE SC Received Amon <br /> ot Permit/ Invoice# Permit IDR <br /> Date Service vest# <br /> Code INFD ath Remitted C <br /> 11-7 <br /> ONSITE WASTEWATER PERMIT <br /> 42-02-OD1 <br />