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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> f SAN JOApUiA COUNTY ENVIRONMENYAL HEAi.Tit DEPARTMENT 304 E WFRER AYE-JM°FL--WOCKCON CA 95202 -(209}468.3420 <br /> i <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS <br /> II 1I JOB <br /> ftTV'IZIPEXPIRES,I Y�EAR rROM DATE ISSUED <br /> Ci'SSSTRE?ADDRE _ <br /> _ Q <br /> APN 7-^_��. .— PA NCEL SIZE T• `�J Ci <br /> J A <br /> OMNER NAME ~ <br /> OWNER ADDRESS C1TyiSTAT0LIP <br /> CONTRACTOR 6'!/ ._ n!"C- PHONE J t/Od �•••�- � <br /> CUN'I'RACTUR AUF.fi <br /> URS_ CtrYt,% TLFLfP <br /> _ 4�LICENSE 42 ❑C-36 <)1'HER .—!.._. NUMBER T T`� <br /> _. _.. _...... .. S EXPIRATION DATE;__,_y� i ilk <br /> WATER TABLE DEPTH;_ -P 11 CEOCRAPHi[AI.INFORMAnoN: Coordinates X I U` <br /> Y 4 <br /> ❑ PERC TEST(S) NLMBER LAND CASE APPLICATION$ <br /> TYPE OFIVORK: ❑ NEWINSTALLATION REPAIRIADDITiON ❑ ENCINEERDt:SICNm/ALTERNATIVE <br /> ❑ RxI.Iw.RMEN7 aayyyy-- ElDESTRt:CT1UN <br /> INSTALLATION WILL SERVE: Ll RESIDENCE *,COMMERCIAL U OTHER <br /> k�,rr NUM8£ROFLIVINGtiN1TS: _ NUMBER OF BEDROO.VtS: NUMBER OP EMPLOYEES: <br /> Int SEPTICTANK 7Yp,,wr <br /> ►'�^--- ---�/-=_t a�f C••AP.gL2T'r'/�O� sal 4 OFCCIMPARTMENTS �{ _ <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY gal A QF COMPAR TMENTS <br /> O PKC TX PLANT DJSTANCE TO NEAREST. WELA _ �— H FOUNDATION F. PROPERTY LIVE / Q <br /> O <br /> LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSMEM) <br /> LEACH LINES $(LEACHStiC-CHAMBERS_ PofLv4rs LENGTH OF LINES <br /> D1SIANCE lO NEARL%T WELL it FOUNDATION—_ t2 PROPERTY LINE I't <br /> ❑ FILTER BED WIDTH ft !,F.NOIH R DEPTH R <br /> DISTANCE TO NEAREST WELL <br /> 13 MOUNDED w1OTH ,_ ft FOUNDA-TION __�(i PRUPrRTY <br /> .___._—_ ft 1.F,wml-� R DCPTH R ! <br /> DISTANCE TO NEAREST 'WELL __, _ 11 FOLNDATION_., ____ft PROPERTY USE <br /> SUMPS WIDTit 11 LENGTH_�. <br /> IT DEPTH___._ <br /> DISTANCE TO NEAREST WELL _ fl FOL:NDA7I0V It PROPERTY LL\E 11 <br /> C] DISPOSAL PONDS WIDTH Il LENGTH'...— `... fi DtPfH —.�.—..-Il <br /> DISTANCE TO NEAREST WL'LL —ti FOL`NDATION_.. R PROPERTY LIN(: R <br /> ❑ <br /> SEEPAGEPITS WIDTH Ft L.F.NOTH ft DFPTH ft <br /> DISTANCE TO NEAREST WELL tt :+UL!1.DA'CiUN f1 PROPERTY LINE ft } <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQL'IN COUNITV ORDINANCES, <br /> STATE.LAWS AND RULES AND REGULATIONS OT SAN JIMQUIN COUNTY. <br /> MI ' UM 2A HOUR ADVANCE NOTICE.RF.QBIRED FOR INSPE ONS-PLEASE CALL 1209)953-7697 �+-1 <br /> SIGNED DATE- <br /> i <br /> I G <br /> � Y 1 <br /> ' S <br /> I I �.rl �• p PA <br /> JL '� <br /> l <br /> � � F <br /> I <br /> I <br /> - DEPARTMENT U. O. ..f <br /> .APPlieatIon Accepted 9 //r``^ _ _ Date 1-3 Z%L Area�,� I�+ bmpioyee IUb_L •S _ <br /> Final Inspection By r o Q ❑ SPECIAL PERMIT-Approved <br /> APP b}'Character of Soil to ptb of 3 Ft: PIUSanlp 5oll Character: <br /> COMMENTS 1 )del forgo •L?!E•t"! _ :ce c•f. •<�k_ t _{�� itgul f <br /> CPZ <br /> C[c.ut.Y �r�r..�ar• � <br /> PE LI <br /> SC Received Checw Amount Permit! - <br /> Coda II o B as Rtmltted DamSarvlcc Invoice# Permit IDp <br /> Re uesl P <br /> 2.15 ;Zso <br /> I <br /> I <br /> '42.0,441 <br /> 12/ 02 ONSITE WASTEWATER PERMIT <br /> I <br />