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SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL] /I DEPARTMENT 304 E WEBER AVE - 3" FL - STocsuroN CA 95202 - (209) 460-3420 <br />NON-REFUNDABLE PERMIT ALL (209) 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED i-- 3 /3 -) 0 C<-.17-3-.5 ie.(' JOH ADDRESS "A:2 - CITYrLIP <br />CROSS STREE1 LA ,....'ll APN l 2- 7 2 (DO 7 PARCEL SIZE 3f 0 <br />741/4Net I 2-4 AJ /04) ..-."-krt, e.../),;1 e7r7e? — -4- C 4,0 i OWNER NAME PHONE <br />OWNER ADDRESS <br />CONTRACTOR <br />CITY/S'EATE/EIP <br />CONTRACTOR ADDRESS <br />CITY/STATE/ZIP <br />LICENSE CI C-42 CI C-36 OTHER /ik NUMBER . I r.s_ EXPIRATION DATE <br />WATER TABLE DEPTH: <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinate X V <br /> <br />PERC TEST <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # <br /> <br />TYPE OF WORK: a NEW INSTALLATION <br /> ie REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT LI DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: a RESIDENCE I0 COMMERCIAL U 01 HER <br /> <br />NUMBER OF LIVING UNI CS: I NUMBER OF BEDROOMS: NUMBER OF EMPlAyEES: <br />LI SEPTIC TANK <br />GREASE TRAP <br />TYPE/MFG <br />TYPE/MFG <br /> <br />CAPACITY gal S OF COMPARTMENTS <br />CAPACITY gal S OF COMPARTMENTS <br /> <br />El PKG TX PLANT DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br />9 <br />CI LIFT STATION SIZE TYPE OF PUMP El SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />51 LEACH LINES 0 LEACHING CHAMBERS ti OF LINES I LENGTH OF LINES 4'0/ ft <br />DISTANCE TO NEAREST WELL 5--1) : ft FOUNDATION / ..., ' ft PROPERTY LINE ft <br />CI FILTER BED WIDTH 11 LENGTH ft DEPTH n <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br />SI SUMPS WIDTH 2. ft LENGTH / -)... k it DEPTH /C-* ' II <br />DISTANCE TO NEAREST WELL /1•Pa., ft FOUNDATION II PROPERTY LINE ft <br />DISPOSAL PONDS Wurni ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELT. Si FOUNDATION ft PROPERT Y LINE ft <br />SEEPAGE PITS NUMBER _ .. WIDTH ft DEPTH ft <br />DISTANCE TO N EAREST WELL ft FOUNDATION 9 PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE. IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />IN IMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />....• . 1 - - I - s- '.....1 `" <br />ATE SIGNED <br />p•-•:::.,7;!.1. L. , <br />" <br />CC <br />• <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> / <br />MOM= <br />MEM= MEM= IIMMIMME MM. MM. MEM= MOIMMEMM <br />MICOMMWM MIEMMIXIM EMMOOMM MEAMMUM MEMPIRWM MOMMEEM IMMEMUW MEM MOM MEM =ME <br />INIUMMEM <br />MEM MEM MMEMMEM MEMMIIMM MM.= =MU =MEM UM.= MM.= =Ern MEM MEM EMMEN =UM =MEM MEM= MMEMINOM =MOM MMEMMEM MEM= <br />1 .14 <br />DEPARTMENT/SE 0,01,1? <br />_Date 3 iLY Area C:9-' // Employee am <br />47e Date 4, 9 -0 4 El SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS .4/f, /6 / iez, CAC ht2; c; i4fe" <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />r CheckiS _..../ Amount <br />Remitted <br />Permit/ Date Ser_aimiLitawisyt IS I nvoice4 Permit 'DP 7 Cash <br />_2-1 0 I/ c Ze-----' F57-0-- / K 0 0/141kTgle00‘7W0S- -- <br />-02401 <br />'122/2003 ONSITE WASTEWATER PERMIT <br /> <br />Application Accepted Hy <br />Final Inspection By :ssaemay Lus