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0bUJd`f <br /> ONSITE WASTEWATER TREATMENT SYSTEM PER-r <br /> SAN JOAQYLN(fOUNTV ENVI RONMENTAL If LACTIC DEPARTMENT 304 E WEBEH AVE-3""FL.-FTOrhTOY CA 95201 (209)46&3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRFSS KC 1 CITY/ZIP V// y <br /> ` C' P-AS S ` A I� (� APN rJ 'T/ A -_I4 PARCEL Sl E t17.7j <br /> CRO\i NTREET v <br /> (` GI <br /> OWNER%AID <,-,—y {Y F-- PHONE F c 4 L{[N.�J - I('.-L}L-� <br /> LOWNER ADDRESS I 1 / ' 1 V _ 1JC + INAT CITY/STATFJZIP 1' Y) L/ <br /> CONTRACTOR % PHONE <br /> CONTRAROR ADDRESS CIT'/STATVZIP <br /> LLICENSE ❑C-0: ❑C-36 O HER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGIUPHICALINFORMATION: CDOrdiDRto X Y <br /> ❑ PERCTEST # BUILDING PERM1IIT# - oSZS L.\ND L'SE APPLICATION# <br /> 1 TYPEOFN'ORK: NEW INSTALLATION ❑ ItEPAUDADDUION ❑ ENGINEERDESIGNEDIALTERNATIVE <br /> 16` ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER L L GU S' N ENO BEDROOMS: Z- NUMBER OF EMPLOYERS:SEPTIC TANK T'PF1MiG CAPACITY I L9 O pi #OFCOMPARTMENTS L' <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY PI #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONWRESr: WELL SU a'�a" R FOUNDATION ft PROPERTY LINE R <br /> j ❑ LIFTSTATION Sae TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> +LFII l LEACH LINES (3LEACHINGCHAMBERS #OFLINES 2 LENGTH OF ONES 40 R <br /> DISTANCETONEAREST WELL C[QL) `— ft FOUNDATION ft PROPERTY LINE ft <br /> I ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft LI <br /> ❑ MOUNDED WIDTH B LENGTH fl DEPTH ft n <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> L ❑ SUMPS WIBTN ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL R FOUNDATION A PROPERTY LINE R <br /> ❑ DISPOSAL PONDS W'IOTn ft LENGTH R DEPTH R <br /> y( DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE <br /> tx SEEPAGE PITS NUMBER ,;I- WmTR 3 ft DEPTH ;2--"; <br /> DISTANCETONEAREST WILL t O.M. tiR FOUNDATION ft PROPERTY LINE R <br /> RR <br /> 1 HEREBY CERTIFY THAT I HAVE ORD ORDINANCES. <br /> S THIS APPLICATION AND THE WORK W ILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQNN COUNTY. <br /> LMINIM1I L'M 24 HOURfADVANC NOTICE REQUI RED FOR INSPECTIONS-PLEASE CALL 12M)953-7697 <br /> SIGNED moi` ILl TITLE S VAN, DATE <br /> `41 <br /> W <br /> L � <br /> [I <br /> R <br /> E <br /> L <br /> ----------- <br /> III A UI C <br /> A <br /> DEPARTMENT 115E ONLY fI�Q <br /> Application AeCep1 DRI. / 2'f'G Area Emp1oY001D# <br /> Final lnspeetion B , Date ❑ SPECIAL ERMMI�T-App.,a by <br /> Cbaraeter 0f Snil m Depth ef3 1: / Pills Soil Charaete,: � -y <br /> COMMENTS A•'f-AJ f-oT of "r—es) <br /> gas <br /> PESC RPIOArd Clucm Atrount Date Permit/ Invoicep Permit lD# <br /> Cede INFO BY Cash Remitted Serviec Re ueatM <br /> L 'fz a 47 0 S vsc A-v � Ih � <br /> ONSITE WASTEWATER PERMIT <br /> 42-03L I <br />