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ONSITE *4wKSTEWATER TREATMENT SYSTEM Annot2MIT <br /> SANJOAQUIN COVNf ENVIRONMENTALHEALTH DEPARTMENT 304EWPAERAVE-3'0p(:-SToGRron CA 95202-(209)468:3420 - <br /> NON-REFUNDABLE PERMIT CA 1.6.:209 953-7697.FOR INSPECTIONS 1EXPIRES i YEAR FROM DATE ISSUED <br /> JOB ADDRESS ICA �a rA-'I h- N l It bA+I CtrvrGr <br /> 3 � <br /> CROSS STREET Y =iA'k 1 C APN C-r`6.Lr� i ..4�. !' <br /> i .. 1F +PARCEL SIZE <br /> 4f. <br /> OWNER NAME ( hPHONEaJ. .d.'-L <br /> OWNERADDRS yI- CTFWSTATFIZIP CA noSsiL.' . <br /> - <br /> CONTRACTOR + cC.Sl^. vtt . PHONE - %,f,-,3931 <br /> /,-,3p,�tt <br /> NJ. <br /> CONTRACTOR ADDRESS - i.. y 'x C/TYISTArPJZIP �>- <br /> LICENSE -42 ❑C-36 OTHER. NUMBER E%PIRATION DATE O <br /> WATER TABLE DEPTH: R GEGGRAPmOCAL INFORMATION: Coordinates X Y 3 <br /> O FERC TEST # RUILDING PERMIT# LAND USE APPLICATION#__ <br /> TYPE OF WORK: 13 NEW INSTALl.AT10N REPAIRIADDD'ION ❑ :ENGINEERDESIGNED/ALTERNATIVE <br /> %k REPLACEMENT )l AAT' k x i QA {IS C X ".dt ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAI1L ❑ OTHER.' <br /> NUMBER OF LIYINGDYlTS: NUMBER OF BEDROOMS: r1+`k'C.« NUMBEROF£MPLOVEES: . <br /> SEP ICTANK j'YPFMFG N..0a. CAPACITY ld^�" gal #OFCOMPARTMENTS ` <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY, gal #OFCOMPARTMENTS. . <br /> ❑ PKG TX PLANT DISTANCETONEAREST: WELL fl FOUNDATION - it PROPERTY LINE it <br /> ❑ LIFT STATION SIZE. TYPCOFPUMP ❑ +SAND OIL SEPARATOR(ENCLOSED SVFTEM) <br /> EJEA HLINES'j❑ LEACHING CHAMBERS OF LINES_ttnn,�nK LENGTH OF LINES a ft <br /> DISTANCE TO NEAREST WELL ISG 11 FOUNDATION !k/+' ft PROPERTY LINE 2510 R' <br /> ❑ FILTER BED WIDTH R LENOTH ft DEPTIi ft > <br /> lfm TANCETO NEAREST WELL (I FOUNDATION ft PROPERTY LME R I <br /> i <br /> (3 MOUNDED WIDTH R LENGTR _ ft DEPTH it <br /> DISTANOET'ONEAREST WELL _ ft. FOUNDATION R PROPERTY LMEit <br /> ❑ SUMPS WIDTn. ft LENGTH-_. R DFFTH A <br /> DISTANCE TO NEAREST WELL.. R FOUNDATION R - PROPEATYLU.E.'. ft <br /> Cl DISPOSAL PONDSWIDTHA LENGTH fl DEPTH It <br /> ,L.A DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> YY'"' }t ,4T- A <br /> fif.. SEEPAGE PITS/ NUMBER WIDTH �^ a R DEPTH e�7,J <br /> DIRrANCE TO NEAREST WELL <br /> ':,aa '�DATION 2 ft PROPERTYIRdE <br /> INF.REBY C�RT7�9 I HAT LHAVE PREPARED THIS APPLICATION AND THE WORK W'ILI.:RE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY _ <br /> ff ORDINANCE STATE LAWS AND RV LES AND REGLLATIONS OP SA NJOAQCINCOUNTY: <br /> 'CF NOTICE RVAHAHEO FOR INSPECTIONS-PLEASE CALL 4209)"3.7697 <br /> SIGNED,f /'0-- `1 TITLE I%Y rnt 4, 0t,^r, DATE..`-1• �•-`"-""". <br /> T k� <br /> RAP NOT TO SCALE `4- <br /> 0 <br /> 33-SEEPAGE PIT 2 LEACH USE 2 z <br /> (I`) <br /> S3-SEEPAGE PIT I TEAM LIKE I Z; <br /> D o <br /> - � rspN yOpOUtN <br /> m <br /> �A1TH EP ENDFF'• . <br /> ci <br /> DEPARTMENT U$E ONLY <br /> I, -a^ � Date-, _ arca ."" f? Emplo>ze.IDN <br /> Application Accepted By ry - <br /> Final Inspection By - Date ❑ SPECIAL PERMIT-Approved by - <br /> t <br /> Character ol'S00toDepth of3Ft: - PitISUMP-Solt Character: <br /> COMMENTS ' ;..-`- �^". • _ _ <br /> PE SC RKeived ;Cb<ektM•,} Amoont Date. Permw - Involcele Permit LD#. <br /> Code mry B• Zi'aSILL Remitted SRrvltt Re ueatk <br /> 12-02-WI - - ONSITE WASTEWATER PERMIT <br /> IL222W3 <br />