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r. <br />ONSITE WASTEWATER TREATMENT SYSTE I <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AYE - <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE IssuED <br />/14LA..1,141 Ap q 3 - 13o - PARCEL SIZE 0- 27_ <br />t- _s <br />Crry/STATE/Ze <br />M PERMIT <br />FL - Si °CATON CA 95202 - (209) 468-3420 <br />JOE ADDRESS <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />, 3 tc rt-,-Am_c__,,; gia R. <br />PHONE <br />CONTRACTOR er t 74-e< Ici ei 4:A44 c.t_.. C-e (V. <br />CoNTRAcroR ADDRESS P 0 aoY (8 .5— b COY/STATE/ZIP <br />LICENSE C-42 Cj C-36 OTHER 44 NUMBER-IP-Z:4- .L-S---q <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION; Coordinates X <br />PHONE .).,3 5 _-7-? <br />EXPIRATION DATE '?" q <br />CI PERC TEST (S) NUMBER LAND USE APPLICATION # <br />TYPE OF WORK; <br />O New INSTALLATION <br />REPLACEMENT <br />INSTALLATION WILL SERVE: VtE(SIDENCE <br />NUMBER OE LIVING UNITS: <br />W.REPAIRIADDITION U ENGINEER DESIGNED /ALTERNATIVE <br />0 DESTRUCTION <br />COMMERCIAL OTHER <br />NUMBER OP BEDROOMS: _ NUMBER OP EMPLOYEES: <br />SEPTIC TANK TYPEIMEG CAPACITY <br />gal <br />CI GREASE TRAP Tyre/Moo CAPACITY gal <br />?KG TX PLANT DISTANCE To NEAREST: WELL <br />ft FOUNDATION <br />LIFT STATION SIZE TYPE OF PUMP <br /># OF COMPARTMENTS <br /># OF COMPARTMENTS <br />PROPERTY LINE <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />$1.4.:EACH LINES <br />CI FILTER BED <br />MOUNDED <br />0/1-UNIPS <br /> <br />WIDTH <br />DISPOSAL PONDS <br />SEEPAGE PITS <br /> <br /># OF LINES 1 LENOTII OF uxes Lt 45 I IS <br />FOUNDATION 1,0 i ft PROPERTY LINE .... 11 <br /> <br />ft IDErTH ft <br />It FOUNDATION ft PROPERTY LINE. ft <br /> <br />Et DEPTH a <br />viEu. k? ft FOLNDATION — <br /> ) <br /> ft DEPTH Z ft <br /> ft PROPERTY LINT ft <br />PROPERTY LINE 7.. ft <br /> ft DEPTH ft <br />ft PROPERTY LINE <br /> It DEPTH <br />I0 LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL 3 <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREpl' WELL ft V(X.NDATION <br />DISTANCE TO NEAREST <br />WIDTH ft LENGTH <br />ft LENGTH <br />DISTANCE TO NEAREST WELL ft FouNnArioN <br />WIDTH fl LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br /> <br />ft PROPERTY LINE ft <br /> <br />I HEREIN CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORN WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN coun"rv ORD1N'ANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY <br />SIGNED <br />MINI UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (2093 953-7597 <br /> TITLE 4:-.1%,v1 f-f °•'-pl" DATE <br />'•1\ <br /> ' <br />111111 <br />tRT1 <br />.zati •10 NG-41T-k Sii4C14,104 <br />oiN;7k ' <br />.00 <br />T'A <br />DEPARTMENT ONLY <br />Application Accepted By a„,..,J 64.0),..,„K 01,0,ate <br />TM <br />-7 _ <br />USE <br />03 Arm 11(0 Employee IDH._ I <br />Final Inspection By 24,4.4. Date 7.../j fie 1 0 SPECIAL PERMIT - Approved by <br />Character of Soil to th of 3 Fr: Pit/Sump Soil C meter: <br />COMMENTS ?i f iS774 7 a.e., <br />PE <br />Code <br />SC <br />INro <br />Received liztr3gs...)cleei , Amount <br />\ Remitted Date ------"---„!"#ke# Permit ICHI By .,...---grEe'rj°aice ReA;fuest # 4-2.17 aso -7/--- 9oor 35'0 -111/Vg. Si( 003 4 g 32) <br />-..._ <br />4241-001 <br />12/242 ONSITE WASTEWATER PERMIT