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/o w <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY EMTRONMENI AL HF.ALIH DEPART%MENT 304 E WEBER AVE-3"'FL-SI OCK'TON CA 95202 - (209)468-3421) <br /> NON-REFUNDABLE PERMIT CALL(2.09',953-7697 FO INSPECTIONS E PERE 1 YEAR FROM DATE ISSUED <br /> 1'�J m <br /> JOB ADDRESS 2 CITY/ZIP �_ -� �'N K 42 <br /> - y <br /> 9 <br /> CROSS STREET / APN OJ O�`r — Q/ PARCEL/SIZE p <br /> OWNER NAME <br /> OWNER ADDRESS4-5 C1'1'Y/STATE/Z1P <br /> CONTRACTOR - C-- PHONE <br /> CONTRACTOR ADDRESS - CITY/STATE/ZIP <br /> LICENSE -42 ❑C-36 OTHER _ NJ-- EXPIRATION 1,12 42 <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X <br /> ❑ PERC TEST(S) \UMBER LAND USE APPLICATION# _ <br /> TYPE OF WORK: ❑ NEW INSTALLATION Al—REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER__ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: _ <br /> ❑ SEPTIC TANK TYPF./MFG_ _- _. CAPACTrY__ ... gal 4 OF COMPARTMENTS _ n <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY _ gal #OF COMPARTMENTS \"^� <br /> ❑ PICG TX PLANT DISTANCE.TO NEARTsr: WF.Lt. ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE ----TYPE OF PUMP r ❑ SA/ND OIL SEPARATOR(ENCLOSED <br /> /SYSTEM) <br /> LEAC14 LINES �r LEACHING CHAMBERS J #OF LINES_L_ LGNGTH OF LINES_- T it <br /> J <br /> DISTANCE TO NEAREST WELL D R FOUNDATION 4�_4? R PROPERTY LINE (t <br /> ❑ FILTER BED w'IDTH _ _ R LENGTH ft DEPTH "�r ft <br /> DISTANCF.TON'EAREST WELL R FOUNDATION: R PROPERTY LINEI--AYIVIr NI 1 R <br /> _.__- <br /> � ❑ MOUNDED wlorH R LENGTH R DEPTH I—iECEIVF_Dn <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ (I PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH 0(-,T �ft <br /> DISTANCE TO NEAREST WELL _ ___ft FOUNDATION_ R PROPERTY LINE ft <br /> SAN JQ Qty <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAResT WELL n FOUNDATION R PROPERTY9°IN�I��"!:'PtI1Gl H�%11 iH DIU S CI(( <br /> SEEPAGE PITS Wlmx 3 R Le lr R UEPI11 <br /> DISTANCE TO NEAREST WELL. o R FOUNDATION it PROPERTY LINE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPL1('A'rION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND RHGUI.AT'IONS OF SAN JOAQCIIN COUNTY. <br /> c NIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20099)953-7697 <br /> SIGNED J —Rp-TITLE �� /lc'/L/ DATE <br /> I < <br /> kz <br /> � I <br /> J � DIEPA E ONLY <br /> Application Acce ed Lo G� le).- - C•'' / <br /> PP Pt _k Date �G Arca Employee[D#_ .sem <br /> Final Inspection By. -� Date Q3 V ❑ SPEC 1.PF,RMIT-Appr b 7 <br /> Character of Soil to PVITof 3 Fr. PiVSump Sol Character: <br /> COMMENTS 'IS <br /> PE SC Received hec Amount PermlU <br /> Code INro a Cash Remitted Date Service Re uest# Invoice# Permit ID# <br /> 210 „- �., a3.� '0 <br /> 42-0I.WI <br /> IL2�02 ONSITE WASTEWATER PERMIT <br />