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• <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />2or( -?ico - 46-0 OWNER NAME /,-)Cd22:3kov- Vav-6,t_A-V PHONE <br />scv_cp %z.D a Iket OWNER ADDRESS CITY/STATE/ZIP <br />Acit Pv-ein 709 - -00C2 L3 PHONE CONTRACTOR <br />tVcjI 1 CA- 2-41 CONTRACTOR ADDRESS 2Jko CITY/STATE/ZIP <br />ft GEOGRAPHICAL INFORMATION: Coordinates X WATER TABLE DEPTH: <br />LAND USE APPLICATION # BUILDING PERMIT # <br />NEW INSTALLATION <br />REPLACEMENT <br />LI REPAIR/ADDITION <br />0 OUT-OF-SERVICE SEPTIC SYSTEM <br />Li ENGINEER DESIGNED /ALTERNATIVE <br />E DESTRUCTION <br />TYPE OF WORK: <br />E COMMERCIAL <br />NUMBER OF BEDROOMS: <br />OTHER INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />RESIDENCE <br />NUMBER OF EMPLOYEES: <br />ft <br />CAPACITY gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE <br />CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) CI LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT <br />13 LEACH LINES Li LEACHING CHAMBERS # OF LINES LENGTH OF LINES <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />FILTER BED WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />ft FOUNDATION DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL <br />DATE - z-1 <br />1. e • COMMENTS <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - SrocKToN CA 95205 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />g PERC TEST # :SSMICRIV 3IIS SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />MOUNDED WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />SUMPS WIDTH ft LENGTH ft DEPTH <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 MINIMUM 48 <br />TITLE •-•••,A-"Li av-f SIGNED <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />. Amount <br />,Remitted Date Permit/ <br />Service Request # <br />Invoice # Permit ID# <br />Lwa ca3 za- 22,017 'F-is-oR 61-01-i-21 SW81-121Q1 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br /> ft PROPERTY LINE <br />ft DEPTH <br />ft PROPERTY LINE <br />ft DEPTH <br />ft PROPERTY LINE <br />JOB ADDRESS I CSEICP SictA'L. FianAjklA cryizip is\-64,-(4-teu 7E-2-Z_ <br />CROSS STREET C-clu1\-8611,- APN 01.1 —O c(O PARCEL SIZE Z-C, ' <br />LICENSE DC-42 DC-36 OTHER V--Ct, 4+-6241 NUMBER 4 3-7 1-7 EXPIRATION DATE