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ONSITE "WASTEWATER TREATMENT SYS TJ Ell,"�'P FE--RNT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCK TON CA 95205-(209)463-3420 <br /> NON-REFUNDABLE PERMIT -ALL(�09)953-7697 FOR WSPECTIONS ""EXPIRES 1, YEAR FROM DATE ISSUED <br /> joD ADDRESS CITY/zIP <br /> CROSS-S)T PEET APN PARCEL SIZE <br /> OWNER NAME PHONE <br /> OVNNER ADDRESS CITY/STATEIZIP <br /> ­,-- -7 �-k 0 <br /> CONTRACTOR <br /> PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE 71C-42 MIC-36 OTHER NUMBER 0325KEXPIRATION DATE_ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> TEST 4 BUILDING PERMIT 9 LAND USE APPLICATION <br /> "'YPE OF WORK: i-i <br /> NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM u DESTRUCTION <br /> INSTALLATION WILL SERVE: /Y RESIDENCE it COMMERCIAL 0 01-HER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> QS SEPTIC TANK TYPE/MFG CAPACITY SRI #OF COMPARTMENTS <br /> GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TONEAREST: WI-LL---- ft F(-)(lNnATION­_--- ft PROPERTY LINE ft <br /> LIFT STATION SIZE TYPE OF PUMP___ 0 PKG TX PLANT 2 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACIAINGCHAMBERS #OF LINES LENGTH OFUNES—Iss ft <br /> DISTANCE To NEAREST wELL 150 it FOUNDATION l7t PROPERTY LINE -56 4— it <br /> 1--3FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION -ft PROPERTY LINE ft <br /> MOUNDED WIDTH — it LENGTH —ft DEPTH ft <br /> DISTANCE To NEAREST VVELL ft FOUNDATION fY PROPERTY LINE ft <br /> Fj SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL fl' FOUNDATION ft PROPERTY LINE ft <br /> U DISPOSAL PONDS WIDTH ft LENGTH H It DEPTH ft <br /> DISTANCE To NEAREST WELL it FOUNDATION' ft PROPERTY LINE itAlV'O'SEEPAGE PITS NUMBER WIDTH ft DEPTH <br /> Lc.' DISTANCE To NEAREST WEI.L_.j <br /> --T- ft FOUNDATION ft PROPERTY LINE_ ft <br /> I HEREBY CERTIFY THAT 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 /> MININIU948 HCUEADVANCE NOTICE REQUIRED FOR INSPECT/0AIS - PLEASE CALL L20�Q.-) 95,9-769-7 <br /> SIGNED z TITLE e-anz DATE 4M-Qq--t' <br /> lK <br /> pm-4 <br /> —————-- Pz <br /> ---LL -T <br /> ) P-� <br /> 1, _RTMENTILIS ONLY <br /> LdE�V' Date Ai�';,, <br /> Application Accepted By eL ---- Employee ID# <br /> Final Inspection By Date 1:1 SPECIALPERMIT-Approvedby <br /> - <br /> Character of Soil to De 'h of 3 Ft: Pit/Z Ulnp Sit chlra e F <br /> I E <br /> COMMENTS (A)imo bser-veik <br /> SCReceived hicmI I. -i�lot1' Dato Permit/ <br /> Invoice# Permit ID# <br /> Code INrO By asi Relittod Service Re Uesth <br /> 74 <br /> ,12-01 oNsru.VVASTEWATER TRTMNT SYSTEM PERMIT <br />