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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT Io,aQ <br /> SAN JOAQUIN COUNTY ENVIRONMENTALHGLTH D[PARTMENT 304E W[BEH AYE-3O-'FL-SI0 KTON CA 95302 -(309)/68-342(1 <br /> NON-REFUNDABLE PERMIT ®� CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROMDATEISSUED <br /> 4g <br /> JOBADDRESS Jl G� /S/N CITV21P Q,J y <br /> 7 <br /> CROSS STREET &b APN f)6PARCELSIlE ZO w O <br /> pO <br /> OWNERNAML PHONL ffek rlZ'733fT p <br /> OWNERADDRESS 5 3 65 Aar,{7P.cn Wv CITY/STATEMP (nitvu) CA g50,)p <br /> CONTRACTOR zemfY�// ��lc.�i / P''HONE//--ZCJ"S-OL7 <br /> CONTRACTOR ADDREM CITY/STATUZIP <br /> LICENSE &LC42 0C-36 OTHER NUMBER EXPIRATION DATE <br /> WATERTABu DEPTH: ft GLOGRAPHICALINFORMATION: CocEdinRks X Y <br /> Cl PERCTEST(S) NUMBER LANDUSEAPPLICATIONX <br /> TVPEOFWORK: ❑ NEN'INSI's LL.IHIN 'a_REPAIWADDITON ❑ ENCMEEROWICNED/ALTERNATIVE <br /> ❑ REPLACLNLNI ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: III RcsIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROFLIVINGUNITS: a7 NUMBLROFBEDROOMS: NUMBER.,EMPLOYEES: O <br /> ❑ SEPTICTANK TYPE/MIO --211 1(✓. CAPACITY Bal ROFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFO CAPACITY 8r1 ROFCOMPARTMENTS <br /> ❑ PK(;TX PLANT DISTANCETONEAREST: WELT. R FOUNDATION ft PROPERTY LINE H <br /> ❑ LIFT STATION SUE TVFEOFPUMP ❑ SAND OIL SEPARATOR(ENLu1RED SYSTEM) <br /> 5& LEACH LINES a LEACHING CHAMBERS ROFLINES LENGTH OF LINES_ 4 <br /> /0 it <br /> DISTANCBT.NEApm WELL Imo+- A FOUNDATION 4T1- it PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH it DEPTH R <br /> DISTANCE TO NEARm WELL R FOUNDATION ft PROPERTY LINE <br /> it <br /> 13MOUNDED WIRTN D LENGTH ft DEPTH R <br /> DIUANCETO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIoTx B LENGTH ft DEPTH it <br /> DISTANCETONEARESE WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIOIN R LENGTH R DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION a PROPERTY LINE R <br /> 42L SEEPAGE PITS WIDTH 31 it LENGTH R DEPTH J'6/ R <br /> DISTANCETO NEAREST W I- /570','- R FOUNDATION S'D'' R PROPERTY LINE f0 R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNT'ORDINANCFS, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM U HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)933-7697 <br /> SIGNED E /inw , DATE Z/Cy�j3 <br /> / <br /> I <br /> O <br /> j <br /> 5 A Ulf C UN <br /> EM MLEMMisium- <br /> DEPARTMENT USE ONLY <br /> ApplbaHon Amepted DoteaaAra_ Emplo,.IDE J <br /> Final lmpedbn Dak J'��a6 AQF (3 SPECIAL PERMIT-Approvedby <br /> CbancleEof SollODe fib f3F1: Pit/Sump Soil Chmckr <br /> COMMENTS _ a <br /> PE SC Recel-d ChmWl/ Amount DRfe Permltl Invoice# Permll lDp <br /> Code INPD g m Remllkd Service umlM <br /> yp sR 3a <br /> 43-01-001 ONSITE WASTEWATER PERMIT <br />