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� c2oa� <br /> ONSITE WASTEWATER TREATMENT SYSTE -sfPER..MIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3""FL-STOCCION CA 95202 -(209)468-3420 <br /> iq,NON-REFUNDABLE,PERMIT CALL(20099)953-/776/9y7 FOR INSPECTIONS EXPIRES II YEAR FROM DATE ISSUED <br /> JOB ADDRESS L2�(' J !.�i I I �1 KC] y CIT'/ZIPST-P Il�rl. If PT m <br /> CROSSSTREET IS u/ a APN i723-300 -0q PARCEL SIM 7, O <br /> `OWNERNAME G}y CEJ MCJ".{ PHONE <br /> TOWNERADDRF55 CITYISTATE'ZIP A <br /> CONTRACTOR IL i 1,E�IL� �y ,�PPHHONE_�B, Gi �t'� A,96 Sl <br /> CONTRACTOR ADDRE53_P(� �C)/ ��[� CI6rvfSTATF/ZIP Kh c',-LCify+- <br /> LICENSE ❑C-02 Ll C-36 OTHER lT NUMBER 1:/S E%PIRATION DATE <br /> WATERTABLEDEPOD R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> `❑ PERCTEST(S) NUMBER LAND USE APPLICATION N v , <br /> TYPE OF WORK: NEWINSTALLATION O REPAIRLADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> O REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: MIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NVMBEROF LIVING UNITS: /� I NUMBER OF BEDROOMS: NUMBER OF EMRS: <br /> AYEE <br /> SEPTIC TANK TYPE/MFG P+L CAPACITY gal #OFCOMPARTMENTS <br /> ❑ CREASETRIP TYPEfMFG 1 CAPACITY gal NOFCOMPARTMENTS <br /> ❑ PKGTXPLANT DIBTANCETONEARESr: WELL IT/S r A FOUNDATION )(�1 it PROPERTY LINE it <br /> ❑ LIFTSTATION SITE TYPE OFIMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 1111011,LEACH LINES LEACHING CHAMBERS III OF LINES 3 LENGTH OF LINES ft <br /> � DISTANCE TO NEAREST WELL ICS 0' ft FOUNDATION Ln/ ft PROPERTY LINE 7 ft <br /> ❑ FILTER BED WIDTH IT LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION IT PROPERTY LINE It <br /> ❑ MOUNDED We. It LENGTH ft DEPTH ft <br /> DIBTANCETONEARErr WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FWNDATION ft PROPERTY LINE IT <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH it <br /> _—/ DISTANCE TO NEAREST, WELL fl ft <br /> FOUNDATION it PROPERTY LINE <br /> 0! SEEPAGE PITS WIDTH SC R LMPB- ;L ft DEPTH . 11 <br /> DISTANCETo NEARER WELL IA 'F R�rFOUNDATION IAB R PROPERTYLIN— EE R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> r STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M�INIMU�B(�}IU HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED 1;;41 trt�� TITLE r n A, ML>f-n£ DATE <br /> 161 <br /> �a CEI 1t <br /> O T <br /> D <br /> yI 1T DEPARTMENT SE O 'LY <br /> Application Aceeptetl By Date IA Area 'r_ Err,IgRPIDp�_ v 414, <br /> Final Inspection By Date v0 ❑ SPECIAL PERMIT-Approved by 7 It <br /> Character of SoiIto Depth f3 FC y Pit/Solnp WI Character: <br /> tars COMMENTS r <br /> PE I SC Received AHMDRt Date Pet" Invoieed Permit IDB <br /> Code ISTD B esh ReMttetl Serelce R uest M <br /> �I , (1363 Sr DC 3t:�'S" <br /> r A3-01-001 ONSITE WASTEWATER PERMIT <br /> Orz 02 <br />