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LICENSE C-42 0 C-36 <br />WATER TABLE DEPTH: toe, <br />PERC TEST # <br />OTHER NUMBER ca141/02425— <br /> <br />EXPIRATION DATE Al <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION <br />DEP A R 1 MINT t:SF ON _le <br />Date -C%-'05"" 0 SPECIAL PERMIT - Approved by /4; <br />Date Area Employee .111)* <br />1 <br />. t: <br />Pit/Sump SoI Character: <br />Application Accep ed-Hg( <br />Final Inspectio liy <br />Character of SolFterDi th of <br />COMMENTS oi <br />--;-2.7r") <br />c--75j" <br />Ul NIT GOU <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 F WEBER AVE - 3"° FL - STociatm CA 95202 - (209) 46B-3420 <br />NON-REFUNDABLE PERMIT CALL (20)) 953-7697 FOR I NSPECEIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ATMRFSS <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />gpc L2(7 <br /> cCe_ fla9(' 1%-te Aph Cs- 0.1 <br />Leit-rtzi 1-7 <br />CITY/STATE/ZIP <br />CITY/ZIP <br />PARCEL SIZE <br />PHONE <br />PHONE 364 -1F3/0 <br />CONTRACTOR ADDRESS -rj1c. -lL p LOCèL <br /> <br />CtTY/STATE/ZiP <br />TYPE OF WORK: 0 NEW INSTALLATION <br />UI REPLACEMENT <br />REPAIR/ADDITION U F\q1NEER DESIGNED LTERNATIVE <br />0 DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: <br />RESIDENCE <br /> U COMMERCIAL HER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />E PT I C TANK TYPE/MFGCNA,Cr <br />CREASE TRAP TYPENR3 <br />PKG TX PLANT DiSTANcE TO NEAREST: WELL <br />CAPACITY ae ga! 4 OF COMPARTMENTS C;•-• <br />CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION 0 I ft PROPERTY LINE 5r) I. <br />LIFT STATION <br /> <br />SIZE TYPE OF PUMP <br /> LI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br /> <br />INC CHAMBERS 5 4 OF LINES <br /> <br />LENGTH OF LINES <br />DISTANCE TO NEAREST WELL <br /> <br />C <br /> <br />ft FOUNDATION (.01' ft PROPERTY LINE C 0 <br />FILTER BED WIDTH ft 1ENOTH ft <br /> <br />DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />MOUNDED WIDTH TT LENGTH <br />DISTANCE TO NEAREST WELL ft RR INDATION <br />CI SUMPS WIDTH T1 LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />SEEPAGE PITS NUMBER WIDTH ?-40 <br />ft PROPERTY LINE <br /> <br />ft <br />DEPTH <br />ft PROPERTY LINE <br />DEPTII <br /> ft PROPERTY LINE <br /> <br />ft DEPTH <br />ft PROPERTY LINE <br /> <br />ft DEPTH 5-- <br />DISTANCE TO NEAREST WELL (sre", FOUNDATION <br /> <br />fl PROPERTY LINE <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 />MINIMUM R ADV 1!0:1) MB INSPECTIONS - PLEASE CALL (209) 953-7697 <br />Alf Ale <br />ENIENEEINEMEINANNE MEE NEEMERVENEEE EEMEMENENNERNME %MEM MiliganiiiNEMME fin commaINEENNEWENEMidliiitt NNW <br /> <br />,--mmimarzsmammagemaa mm • EMEEENNEWA NMEMENNBUWWW. . <br /> <br />N:AMEMENEEEEENE ME MI —ONNEMMUW- EENEWEEMEEENN NINNOM ,Amm mosemmumahadivr _AMENMENEMEMENE ENNEENNWANEM =MERE= ====== EENNENNEYNEZE =ME= ====== ENNINIENNIMENENE EMMENEE NEMNEENNEEM ENNEEMENEEEMIE ENEEMI„ . MEMMEMENEM ENEENEIWWIEWEENNEN ENEMMIL ENEWEEMENE NEENNENIMIN MIMI ENE= Mile =MEN =====kEM NEMENE ENEW <br />MEMMEMEMM EMMEMMINIMEM MEE= =OE' =EMMEN_ EMEENNERMENNkMMANNENN ES= EMEMENE IMMEENNEWEEMMEEMMENNEMEN "W.14 =mommommilmummimmummommimmE_mmow.-- mom= miimmEMMEMMII 1111111mmEME "NM <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />-..6er.l.d9- <br />Cash <br />Amount <br />Remitted Date ermi <br />_ <br />Invoice # - ------C-1,- <br />Permit ID - .ervice FtaIllIPK4+ )--•',,--',.., <br />Ilaul tic:,/ &L, -,.-R. 1 S-0 /—/ 512.00 35 5-8 5- .,::, <br />- " - - A L A - % (--:-.-76( e.-.) c--------,---„, • ,.. , , .------, <br />SIGNED <br />11111 11111111111111 111111111m. =EN ...fl NENENNEMEE MEMENNEEN= <br />42-02-001 <br />ONSITE WASTEWATER PERMIT <br />12/22/2003