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NUMBER LICENSE fik..42 1,-J C-36 OTHER EXPIRATION DATE 69- ?/-/ BUILDING PERMIT # LAND USE APPLICATION # L NEW INSTALLATION jtr.,.. REPAIR/ADDITION C REPLACEMENT C OUT-OF-SERVICE SEPTIC SYSTEM 0 ENGINEER DESIGNED /ALTERNATIVE C DESTRUCTION INSTALLATION WILL SERVE: 0 RESIDENCE NUMBER Of LIVING UNITS: )1 COMMERCIAL 61-414 Y9 0 OTHER NUMBER OF BEDROOMS: NUMBER Of EMPLOYEES: WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X TYPE OF WORK: PERC TEST # JOB ADDREss /1/// E X CROSS STREET 140 - Cre) APN OWNER NAME /4/ 772a4e OWNER ADDRESS c4A.L/G.,111.)1 CONTRACTOR /';':,/22/7/ 1,42/./ery Crrv/ZiP 4 1.k.") 9.5-zi5— PARCEL SIZE 4_4 -ftrii? PHONE s-- 705-- /LYK CITY/STATE/ZIP DyKJ PHONE s-oz CONTRACTOR ADDRESS CITY/STATE/ZIP icr'..Z; -3 b el -2_00-31 /P7,) ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - SirocKToN CA 95202- (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED SEPTIC TANK ID GREASE TRAP TYPE/MFG Ppkid4„ir. TYPE/MFG DISTANCE TO NEAREST: WELL CAPACITY gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINE ft LIFTSTATION SIZE TYPE OF PUMP 0 PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) CI LEACH LINES n LEACHING CHAMBERS #oF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL FILTER BED WIDTH ft LENGTH DISTANCE TO NEAREST WELL It FOUNDATION MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION DISPOSAL PONDS waTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION SEEPAGE PITS NUMBER he) WIDTH C DISTANCE TO NEAREST WELL ;c10' t ft FOUNDATION •Mowe. I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS Of SAN JOAQUIN COUNTY. MINI M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 TITLE tYZa.4 E- DATE PGA, i 1---- I 0 1 - 0.7 I., , -49--• ! .46 . .F. Z . . .-.. ''.' '.....Lff ‘A r • •••••• F • r K PA i i . . t k ENT t!: ' • . 4 - - .. '' 7- ECEIVF-7U „IL...L. j JUL Z ilVilue. ----‘1; . . . s. II I ENVi mg .•JN-y - — • "4' TIV'ENr i I " Application Accepted 8 7 Final Inspection By9 r.75....... • 17' Nfir Character of Soil to a th of 3 Ft: Pit/Sump Soil Character: .13EPARTM_EN_TrE/ONLY Date -7 2,0 / Area Employee I DO Date .7/2-3/M X. SPECIAL PERMIT - Approved by COMMENTS ot 7- -c2 Lo oF A-e_co.4,e) . ecALC _slc-/-4Ac__.-7-0 tii-f,e7 4,-/C---c-4- • 5',Ecros-c- f)E.,--xt (r -€v ro,e---Pir_c- 0 AJE-A1 ..-A0_, a ,e- ,P,e1-4.c. rr(s) LA- i 17-of 1) i -r-x ,9^-di-if PE Code SC INFO Received By Amount Date mitted A Permit! Service Request # Invoice N Permit ID# 42_(-7 2_5-s 14 Or- WIO 0 •EW &Oct DO 7 OM o.V.410 eP05-*(0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTFI ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft DEPTH ft It PROPERTY LINE ft ft DEPTH .15 ft ft ft PROPERTY LINE SIGNED