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3• 30 <br /> ONSITE WA&,EWATER TREATMENT SYSas.4M PERMkT�w w11►1� ' <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE -31°FL-STOCKTT�aL z9) <br /> 41i5-3420 <br /> NON-REFUNDABLE PERMIT d CALL 209 9513-76977 FOR NSPE 1 NS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3�7 Y �3� �'S L/ "1 CITV/ZIP �C O CA ' v' <br /> Q p., <br /> CROSS STREET Yb\i ti'\E�I�n APN ��' [�0 �� 0 L PARCEL�SIZE <br /> 0 <br /> OWNERNAME AIA N kti t om- PHONE M <br /> /��j <br /> ,qV t N <br /> OWNERADDRESS :3T-�701 VCITY/STATE/ZIP 1 /�a-'e7 340 y <br /> CONTRACTOR 1n-V EC. IA)C- PHONE <br /> CONTRACTOR ADDRESS lac _ '''G CITY/STATE/ZIP Cic 6A/ Com.. Z <br /> LICENSE ❑C42 ❑C-36 OTHER +/Q NUMBER EXPIRATION DATE / O <br /> WATER TABLE DEPTH: I a'a r R GEOGRAPHICAL INF ATI I tes X Y <br /> LIPERC TEST # BUILDING PERMIT# e . +2-L LAND USE APPLICATION# A-- O -70 <br /> TYPE OF WORK: NEWINSTALLATION ❑ REPAUVADDITION ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBEROFLIVING UNITS: NUMBER OF BEDROOMS: / NUMBER OF EMPLOYEES: <br /> Ef SEPTICTANK TYPE/MFG fJ42 CAPACITY 2Of�� QAI gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> (3 PKC TX PLANT DISTANCE TO NEAREST: WELL ..J 4u t -fl, FOUNDATION ft PROPERTY LINE R Lk <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) W <br /> G <br /> LY LEACH LINES ❑ LEACHING CHAMBERS #OF LINES Z- LENGTH OF LINES (00 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME R <br /> LI SUMPS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE R <br /> LIDISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> SEEPAGE PITS NUMBER fo W WTH -2�6 f ft DEPTH S ft <br /> DISTANCE TO NEAREST WELL /OC) ws s...R FOUNDATION ft PROPERTY LINE it ^� <br /> I 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 REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �� MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPE;JCTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED LLiriwv>. �j.//C-OC TITLE //�-� W�a D/ �'Z7 CL. <br /> L0'>S0.0£ <br /> IlmifUdS <br /> C5 In r II T,V Mn uZ V01 'tv.(V. ¢�ILLm <br /> FF rr�'ofi J{ 1KWMYkM X'001— <br /> p J 3NIlH�1'3� ,Y.09 t t E Lv <br /> z <br /> $ F <br /> na 4 <br /> IYOY N `, 2 <br /> NY O�U�6�W Y <br /> SA <br /> - F. <br /> �_ _ Lit Lr DU <br /> 66 ),VMHOIH 'OS ENVOIRONP EI TA <br /> DEPARTMEN2-110 <br /> '3747 <br /> Application Accepted By Dale 21 0 Area Employee ID# <br /> Final Inspection By Date 124-'Y /TV �o ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil b Depth of 3 Pt: PltlSump Soil Character: <br /> COMMENTS 0L0 4-0-r 0 249C0 °.d 456F-M6,E ydrl—S S'F[aK.L-AAL wr [..E+4ST lot, F7' FO-0aM <br /> &(/5- e / / 'cha.� /tel�r'I� cA k o� Q)D vrwr/ je <br /> 0 80 f✓ <br /> PE SC Received Cheek#/ Amount Date Permit/ Invoice# Permi[ID# <br /> Code INFO B Cash Remitted Service Re est# <br /> y2 . rG zso G Snv.ua � Z 6b <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/32/2003 <br />