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ONSITE W I STEWATER TREATMENT SYSTEM 7RMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTALIN DEPARPMWT 300E WEBER ME-A BoIE KTOry CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT y CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADostru 1404 Al 9 Li IN IS—L/G Aj-i ,.C�ITWZIIP�' CK rZvO <br /> CRO95 STREET �.,.,.b��/4?e [ ,t' /s APN ACl���(/1�$J•'r r PA SI D <br /> OWNER NAME 5;7w`T�/J .pym?'VA I AL (fF. • PlIONE-,/ a <br /> OWNLRAOORESS /330 /y. r)2o 13�y C,-7-� /}CCLT(�`STATP/ZD OtK 1+7� <br /> CONTRACTOR K��`INfFL —� INC'.• l T// — <br /> COxTMCTORADD0.E5800�� �� M� �I'_ CITWSTATE21Pr�OC�T�n} CIO" /S bT <br /> Lic"JES ❑C-Q LI C-36 OMER NUMBER EXPIBATNNN DATE <br /> WATER TABLE DEPfN: 0 GEOGRAPNICALINFORMATNIN: COOMiAStea X Y <br /> Zl'PERC TEST IS) NUMBER LAND USE APPLICATIONM <br /> TYPE OF WORK: ❑ NEWINSTALIATION ❑ REFAIWAODRION ❑ ENGINRERDPHICNED/ALTLpNATYE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL _q G❑ OTIIER <br /> NUM1110P LIYIRIG UNITS: NUMBEROF BEDROOMS: D21TL ihl ?f NUMRPYOFEMPLOYET9: <br /> ❑ SEPrICTANK TVPE/MFO CAPACITY 8EI M OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPWMFO CAPACITY gal X OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCLTONrARRT: WELL B FOUNDATION R PROPFRTY LINE R <br /> ❑ LIFTSTATION Sin TYPE OF Pump ❑ SAND OIL SEPARATOR(ENCLoscDSYsTEm) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS N OF I-INES LENGTH of LMES ft <br /> DEPI'ANCETONEAREST WELL R FWNDATNN fl MOPERTY LINE fl <br /> ❑ FILTER BED WI. R LENGTH ft DEFTF, <br /> OUTANLETON[ARLST WELL A FOUNDATION B PROPERTY LINE fl o <br /> ❑ MOUNDED WIDTx It LENGTH D DEPTH A <br /> DLTI'AmmE NEAREST WELL R FOUNDATION B PROPERTY LINE R <br /> ❑ BUMPS WIDTIf D LENGTH B DEPTH R <br /> DISfANCETONLAREEr WELL 0 FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL FONDS w.F. R LENGTH B DEFT" ft <br /> DLYI'ANCETONFARHST WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ SEEPAGE PITS WIDTH It LENGTH fl OFF. It 0 <br /> DmANCE TO NGREET WELL IF FOUNDATION ft PROPERTY LME ft <br /> I MLRGY TIPY TNATI VL PR RL IS APPLICATION AND THE WORK WILL BE DONE IN wCCORDAxcr WITH SAN JOAQUIN COUNTY ORDINANCES, IDT <br /> ATL LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. L <br /> 4 INT UR ADVANCE NOTICE REQUIRED FOR INSSP,EC7HOCN.S-PLEASE CALL(209)953-7697 {/ Tn <br /> SIGNED TITLE .orf-� Fwta�N1:F�_ DATE • O -� `L <br /> A <br /> O <br /> a <br /> 0 <br /> M � <br /> OS <br /> p14q <br /> 0 <br /> LL <br /> DEPARTMEWUS5 ONLY <br /> Applirallon ArCWM By 11'4' Date U Arta ul EDplgm lOp �J9 49 <br /> FiDvl lnaPembD By DON, !S 0 SPECIAL PERMIT-Approved by <br /> CharMW of SDI)m Depth of 3 Pt: PIUSump ell Chvnebr. <br /> COMMENTS 3, la obsGe AI 0,kh <br /> Nr W2WdRaeAJ. LfiuDleUe 4fl§[Qq no JFfh: {ales rt*a m�kA^�neseak <br /> PE SC Received h Amount Dat Permit InvekeM PermM IDM <br /> CO4 InPD B Cvah Remitted ServloeR SE., <br /> 37 <br /> 42-01-001 <br /> ILL62 ONSITE WASTEWATER PERMIT <br />