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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCK'rON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE <br /> PERMIT/ a`�.LLCALL 2099 X953-7697 FOR INSPECTIONS EXPIRES IAYEAR FROM DATE ISSUED <br /> JOB ADDRESS CllJo �&. �K=M'C+V&K I�kN F [Q Coup L.ODZ 95�O _ y <br /> CROSSSTREET CYC APN OS�- {ID 00 PARCEL SIZE 487- <br /> OWNER NA-ME <br /> 87-OWrIEANAME dJO�IN� KT2SC1�JM1k�l PHONE I�/�yb�- 3� � <br /> OWNER ADDRESS L�t7 L CITY/STATE/Z <br /> ZIIP <br /> M 1� <br /> CONTRACTOR nC77,01 <br /> Po q r�/f.4 1 G �'IJ/C�/ PHONE WPI JI�I-Z�S•L <br /> CONTRACT��ORRADDRESS ,0 1 5. GLVZ...D ACV& �CP'3 t� CITY/STATE/ZIP LODT-i CAr 45?A'0 <br /> LICENSE 4 C-42 Q CJ6 OTHER NUMBER -754 ,-A EXPIRATION DATE 0 -IZ45`01 <br /> WATERTABLEDEPTH:_ It GEOGRAPHICAL INFORMATION: Coordinates X _ Y <br /> O PERC TEST # ^� BUILDING PERMIT# - 0-70-2-172& LAND USE APPLICATION <br /> TYPE OF WORK: NCW INSTALLATION O REPAIR/ADDITION O ENGINEERDESIGNEDIALTRRNATIVE <br /> O REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: 9l RESIDENCE O COMMERCIAL O OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBEROF BEDROOMS: Z NLMDER OF EMPLOVEES: <br /> p SEPTIC TANK TYPEIMFG �1 •��r CAPACITY �W O gel #OF COMPARTMENTS _ <br /> O GREASE TRAP TYPFJMFO CAPAC TV �1 gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL LCIQ.I f- It FOUNDATION 12-' ft PROPERTY LINE (Ota I ft <br /> O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES W LEACHING CHAMBERS #or LXNES LENGTH of LNEs 4IOI R <br /> 1 , <br /> DISTANCE TO NEAREST WELL loo It FOUNDATION PROPERTY LINE 35 It <br /> O FILTER BED WIDTH ft I.SNGTH _ft DEPTH ft <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION ft PROPERTY LITE It <br /> O MOUNDED Wmni ft LENGTH ft DEPTH ft SC <br /> DISTANCE TO NEAREST WELL ft FOUNDATION A PROPERTY LINE ft <br /> O SUMPS WIDTH ft LENGTH_ ft DEPTH R n <br /> DISTANCE TO NE..mmT WbL.L _ft FOLNDATION ft PROPERTY LINE ft r <br /> O DISPOSAL PONDS WmrR ft LENGTH_ ft DEPTH It ?' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER CI WmTH 3� ft DEPTH 'J-`J t ft •A <br /> DISTANCE TO NEAREST WELL I OO f} R �OVNDA'IION fft PROPERTY LINE 52 ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGU LATIONS OF SAN JOAQUIN COUNTY, <br /> MINIM24 HOUR ADVANCE NOTICE REQUIRED FOR INSPF(-nONS-PLEASE.CALL(209)953-7697 , <br /> SIGNED ` TITLE_ JLf � DATE k0 j C3:7_ <br /> 3. <br /> 1 ' .A <br /> NpFPAC01j, )Y <br /> DEPARTMENT U E ONLY <br /> Application Accep <br /> Date 10 z z Area Employs IDA, <br /> Finallaspection y Date O SPECIALPERMIT-App !!v .by <br /> Character of Sol th of 3 PIVSump Soil Character: Bt y <br /> COMMENII'S O LO L-u k--)f-C.O—Z-A <br /> PE SC Received heel0l Amount Date Permit/ Inv ce ermit D# ti <br /> Code INTO B Cas Remitted Service Request# <br />