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_4 ONSITE WAST, ER TREATMENT SYSTI `_ �-2RMIT <br /> 304 E WEBER AVE 3"'1_�I.-S'1'0('K'[()N CA 95202 (209)468-3420 <br /> s_1rqJ0AQIIlN COUNTY I.�NVlR0Nr,%V.NTAl.I I EA L'I'll DEPAliTNIEN F AR FROM DATE ISSUED,, <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YE <br /> CIT1,/ZIP L11 <br /> Jon ADDRESS �4 <br /> APN 4", PARCEE.SIZE <br /> CROSS STREET A <br /> OWNER NAME WA 6 PII0Nv <br /> I 4 i <br /> GLC CITY/STA.TF./ZIP <br /> OWNERADDRESS PTIONE <br /> CONTRACTOR <br /> CITY/STATE/ZIP 4Z91- 6!%1-k <br /> CONTRACTOR ADDRESS <br /> LICENSE U C-42 LI C-]6 OTHER <br /> NUMBER EXPIRATION DATE <br /> WATER TABLE,DEVVH'. % TION. Coordinates x Y <br /> 11 GEOGRAPHICAL INFORMA <br /> 0 ,PFRCTEST 4 BUILDING PERMIT#— LAND USE APPLICATION## <br /> TYPE OF WORK: LJ NEW INSTALLATION j REPAIRIADDITLON ❑ ENCINEER DESIGNED/ALTERNATIVE <br /> Ll REPLACEMENT U DESTRUCTION <br /> INSTALLATION WILL SERVE: Q RESIDENCE LJ comNIERCIAI. El ariwilt <br /> NUMBER OF LIVING UNITS: NUMBER OF RFDROOMS: NUMBER or EMPLOYEES: <br /> 0 SEPTIC TANK CAPACI I Y gal P OF COMPARTMENTS <br /> 0 GREASE TRAP TYPE/MFG— CAPACITY gal 4 OF COMPARTMENTS <br /> PKC TX PLANT DISTANCE ToNEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION Slzr_ TYPE OFPuN%P ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES Ll LEACHING CHAMBERS 4 Or LINES_ LENGTH or LINES ft <br /> DISTANCE To NEAREST WELL ft roUNDATION_ft' PROPERTY LINE ft <br /> ❑ FILTER BED WIDTII ft LENGTH f, DEPTH R <br /> DISTANCE To NEAREST WELL_ 11 FOUNDATtON ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH I DEPTH ft <br /> DISTANCE To NEAREST WELL_ ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH 11 LENGTH DEPTH ft <br /> DISTANCE To NEAREST WELL N ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS W1DTl1I ft LENGI 11 ft DEPTH -ft <br /> DISTANCCTo NEAREST WELL— ft FOUNDA110N ft PROPERTY LINE <br /> ft <br /> LJ SEEPAGE PITS NuMBER WID111_ ft DEmu <br /> Il <br /> DiSTANCE'ro NEAREST WELL_ ft FOUNDATION ti PROPERTY LINE <br /> tt <br /> IHERt. -'V'THAT YAVE PREPARED THIS APPLICATION AND THE WORK WILI,HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> RDINANCE.S,�TATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> I HOUtt ADVANCE NOTICE REQUIRED FOR INSPECTIONS- CALL(20,4)953-7[,97953-7[,97 <br /> SIGNED TITLE DAT, <br /> r-—————————— <br /> L—— ——————— <br /> 171 <br /> 4-1 <br /> ————— ———————————— <br /> L <br /> DEPARTMENT USE ONLY I(qj <br /> Application Accepted By Date Area wV103 Employee I D4 <br /> 0 SPECIAL PERMIT-Approved by <br /> Date <br /> Final Inspection pit/ Soil Character:- <br /> Character o oil o Depth f Ft; Sump <br /> COMMENTS <br /> SC Received PE SC 'R4 Chec Amount Date Permit/ Invoice Permit ID4 <br /> Code INFO 0 Cash Remitted Service Request <br /> 0 <br /> j q,3 -jc)qo <br /> ONSITE WASTEWATER PERMIT <br /> 42-02-001 <br /> 1 7f22/2nff3 <br />