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ONSITF --'ASTEWATER TREATMENT SYSTEM P`MIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTA*,,,,,�i,TH DEPARTMENT 304 E WEBER AVE-3" 1�'CKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> t' y <br /> � JOB ADDRESS i -CITY/LIP � <br /> CROSSSTREET I .. -Q--1 APN 1 D -;I:, i Z'J D I�PARCEL SIZE T. J� p <br /> l 1 0 <br /> OWNER NAME N-�A� "` 4.V "{� �. <<'���" PHONE y <br /> f q <br /> OWNER ADDRESS `1 1 2ll —, CITY/STATE/ZIP- <br /> 'II I I � PHONE <br /> CONTRACTOR <br /> _ CONTRACTOR A DDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEDGRAPHICALINFORMATION: Coordinates X Y � <br /> l <br /> P PERC TEST F#qLWNG PERMIT# LAND USE APPLICATION# v - <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTF1lNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPF/MFG CAPACITY gal #OF COMPARTMENTS r1 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS J` <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE ft \`` <br /> V" <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i I <br /> I <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R / <br /> ❑ MOUNDED WIDTH R CENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH R j <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WmTH ft LENGTH ft DEPTH ft <br /> j DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 NO ICE RF.QUI RED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED'f-- DATE l� DATE <br /> j <br /> i <br /> a Z� <br /> In <br /> JuLjq COUNTY <br /> NO/,d14N EN R N <br /> a DEPARTMENT 11SE LY <br /> i G <br /> Application Accepted By � _ �—/ /�' Dale '� Area � Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by / <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Sol]Character: <br /> COMMENTS <br /> PE SC Received bee Amount Dat Permit' Invoice# Permit ID# <br /> Code INFO By/— Cash Remitted Service Request# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> — 11/22/2003 <br />