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'/�7 y� <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTIt DEPARTMENT 304 E WEBER AVE -3""FI.-ti'FOCI(TON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMI I CALL(209)953-707 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRISS �'� c� S�Z4 C �7[•'.�/� CITY'ILIP I-AT &P 9s 33G� <br /> T J fY� J <br /> CROSS STREt-[• API, o 30 l/�-1 L> PARCFL SIZE ^''J• I r�C p <br /> Y c <br /> OWNER NAVIF. WA 1,. F-A.2>=4'rD PHONE. 9g z -1'199 <br /> OWNER ADDRi•S.ti C� n/fid -� CITY/STATLIZIP LA 7�IZC) f!A <br /> CO%'TRACTOR i^• C^G`��S G�L%N(y PHONE <br /> CDNTstACrOR ADDRFSS CITY/SPATE/ZIP <br /> LICENSE ❑1.-42 O C-36 OTHFR_ NLMBER EXPIRATION DATE —1 <br /> WATER TABLE DEPTII: _�(� / �— ft GEOGRAPHICAL INFORMATION: Coordinates X v <br /> ❑ PERC TEST p 13l ILD(NG PERMIT# LAND USE APPLICATION#_ NSA <br /> TYPE OF WORK: 3 NEW INSTALLATION ZI REPAIR/ADDITION LJ ENGINEER DFSIGNED/AI.TERNATIVF <br /> D RFPI.ACLMENT ZI DESTRUCTION _ <br /> INSPALLATION WILL S£RVE; ❑ RESIDENCE U COMMERCIAL U OTHER_ <br /> NCMBLR OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF FMPLOYEES: <br /> ❑ SEPTIC TANK TYPE MFG__ _ CAP.aCITY gal ?t OF COMPARTMENTSZIP_ <br /> ❑ <br /> GREASE TRAP TvrE+MFG— _ CAPACny gzl X OFCUMPARTMFNTS N <br /> ❑ PKC TX PLANT DISTANCETONEARLSI: WELL ft FOU\DAII(IN R PROPTRIY LrNF. ft <br /> ❑ LIFT STATION SILL TYPE OF PUMP _ ZI SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACII LINES U LFACHING CHAMBERS R OF LrNES LFNUTH Of LINES ft <br /> DISTANCE TONF.ARF.ST WCLL III FOUNDATION ft PROPERTYLINE ft <br /> ❑ FILTER RED WIDTH _fl LENGTH_ ti DEPTFi tt <br /> DIST.ANCE10,NEARESI' WELL It FOUNDATION fl PRUPEKIYLINE n <br /> ❑ MOL!NDED WlnTtt_ _ft Lr`:GTII ft DEPTH ft <br /> DICTANCEToNEAREST WELL it rOLNDATIO% fl PROPERIY LINE R <br /> SUMPS WIDTI{ fl IYNGTH ft DEPTH R <br /> DISTANCE TO NEAREST 1F E1 1. _ n ru:NDATION 11 PROPERTY LINE _ tt <br /> DISPOSALPONDS WIDTH ft LF.N61H 4 ft DCPi,H ft <br /> DISTANCE TO NEAREST W'FLr. t[ FOIINr)kTION 11 PROPERTY LINE H <br /> L] SEEPAGE.PITS NCMBER _WIDTH fl DFPI'1I fl <br /> DISTANCE.TO NEARESI WELL ft FO[:NDATION R PROPERTY LINE ft <br /> I HEREBY CE 1F1'TH.YT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BF.DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> 'dikPINANCES,SPATE LAWS AND RULES AND RECULATIONS OI'SAN JOAQLIN COUNTY. <br /> �11N 1 1 UR AHYANCE NOTICE RE(1UIHF1►FOR INSPECTIONS- I'LE.ASE CA1.1.1204j 453-761)-- _ 1 <br /> L <br /> SI(;NF.b � G 2�� � TIT1.F,_ t _ DATE <br /> r <br /> 44 <br /> -LL I <br /> ALL <br /> I <br /> VI O M TjL <br /> 1 J H HOE ITIVENr <br /> LA <br /> .P•�RTti1t:NT IISE L1r' <br /> Application Accepta*Byv , 1 Date f 7 d Arca /(i Employee Mt.Final Inspection P..y Uale ❑ SPFCIAL PERMIT-Approved by <br /> Character ofSoii to : _ Pit/Sump Soil Character: <br /> C'OMMLN 1 S <br /> Pk' SC Received eek#/ Amount Permit/ <br /> Crde INFO Ry as Remitted Date Service Request N ]nvolct b Permit IDp <br /> _ 02 1 `t uS <br /> 2. <br /> z� Z <br /> 42.12-001 ONSITE WASTF.WA'rE'R PERMf1 <br /> 12:22:2003 <br />