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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY Fti, NMf-N I At HE AT iH DEPARTMENT 1868E.HAZE.t ION AVENUE-STOCK TON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT r CALL(209 953.7G97FO1+IvsPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /��f'� CITY/ZiP r�,Ot` �_. L->YE <br /> L (�. <br /> CROSS SrREET -- --------__..-- APN_.DLIZ�_l 1 ���"S PARCEL SIZE f e) <br /> - - <br /> OwNTnNAME l,���d/.----�.IDI'✓1,/.2.� __..-.- ---..-- PHONE-Z--' <br /> OWNER ADDRESS --- --_ _ CrTV/STATEMP _ <br /> CONTRACTOfl � v' -- -__ _-�i.rw^J�l.,(L _ PHONE -�� <br /> CONTRACTOR ADDRESS .IQZ.Z /_ _ •J�IH -7- A' CITY/STATE/ZIP <br /> LICENSE -42 ,C38 t3THER_�__ -_ NUMBER- /C�y% EXPIRATION DATE <br /> WATER TAR LLFF DEPTH: 1E GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> C_FERC TEST C I BUILDING PERMIT II __ LAND USE APPLICATION#____- <br /> TYPE OF WORK NEW INSTALLATION y` flEPAIR/ADDITION ENGINEER DESIGNED ALTERNATIVE <br /> REPT ACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: �A' RLSIDENCE COMMERCIAL <br /> NUMBER OF LIVING UNITS: - NUMBER OF BEDROOMS:_rNUMBER OF EMPLOYEES: <br /> C] SEPTIC TANK T,PEfMr;, CAPACITY gal K OF COMPARTMENTS_. <br /> J GREASE TRAP IYpi-!MrC, CAPACITY _ gal 4OF COMPARTMENTS <br /> DISTANCE TONEARFST: Wh it FOUIDATION�. It PROPERTYLINE <br /> 13 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �(L]_ LEACH LINES LEACHING CHAMBERS _ #OFLINES LENGTH OFI - •____ _ft <br /> DISTANCE TO NEAREST WELL Q It FOUNDATION 10'-4 It PROPERTY UNE S_ f' It <br /> U FILTER BED WIDT:; _It LENGTH it DEPTH_ _ R <br /> DISTANCE to NEAREST WELL It FOUNDATION ____ It PROPERTY LINE R <br /> U MOUNDED WIDTH it LENGTH II DEPTH It <br /> DISTANCE TO NEAREST WELL--- It FOUNDATION- tt PROPERTY LINE fl <br /> SUMPS WIDTH _ -- _ R LENGTH_..—. ft DEPTH.- <br /> DISTANCE To NEAREST WELL_ It FOUNDATION ft PROPERTY UNE_ It <br /> J DISPOSAL PONDS WIDTH ft LENGTH _ _-__... _ ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION_ It PROPERTY UNE <br /> SEEPAGE PITS NUMEIER ',�. - MOTTH/� � ft DEPTH Z ft <br /> DISTANCE TO NEAREST WELL `_L'Q - ft FOUNDATION 1� _ it PROPERTY LINE_�lT _. it <br /> I'!ERERY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATF 1 AWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> A7/NIMUM 24 HOUI7 ADyANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE --^-� DATE �� <br /> t ' <br /> N _ <br /> A c: Lit In <br /> TPL <br /> — <br /> _ — <br /> _L VI O T <br /> 111 <br /> i <br /> DEPARTM NTLI ONLY _ <br /> Application Accepte�Sjr / ' Date ! z e:i Employee IDC <br /> Final Inspection By Date / f��_ SPECIAL PERMIT-Approved by <br /> Character of Soil to D of 3 Ft:__ ___ Pit/Sump Soil Character <br /> MMMENTS <br /> PE SC Receiyetl Amount Date Permit/ Invoice F Permit IDR <br /> Code INFO B Remitted Service Request C <br /> ZIJ 11i $ LCL 1 2G 4,S 7 4-E <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42412 <br />