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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT DAes2g2-Izogl<ee aa2g <br /> SAN JOAOUIN CcINTY ENNM <br /> RONENTAL HEALTH DEPARTMENT <br /> NON-REFUNDABLE PERMIT CALLLi 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED m <br /> JOBADDRESS S / CITYMP <br /> CROSS STREET <br /> APNPARCELSIZE �f� 0 <br /> PHONE 'ant Cuci-77 9 <br /> OWNER NAME L+ y�� eZ' <br /> OWNER ADDRESS CITYISTATERIP <br /> ''�� G PHONE jp G_tn77 <br /> CONTRACTOR (y� y .. Zack- <br /> 1 CONTRACTOR 7'axJ "C>iU'ef /�JA/I� CITYJSTATEZP <br /> ^ LIGENBE A42 JC-98 DTNER NUMBER 9SW S' EXPIaxr ONDATE <br /> I <br /> I- -\WATER TABLE DEPTX: R GEOGRAPXICAL INFORMATION: CoorDlNte: X Y <br /> ❑ PERC TEST # BUILDINGPERMIT# LAND USE APPLICATION# <br /> TYPEOFWORK: O New INSTALIATIOn 0, ReFAIPJAvOMcW a <br /> j ❑ REPLACEMENT 0 OUT-OFSERVICESEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: I� RE810ENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROFLIVWGUNITS: I N,U/mwaFOFB®ROOM:: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG ffw 0.0/ I�S't CAPACITY)64ti gal #OFCOMPAATMENTS� <br /> ❑ GREASETRAP TYPSMFG CAPACITY gal #OFCOMPARTMENTB <br /> DISTANCETONEAN S : WELL SCS R FOUNDATION �, A PROPERTY LINE <br /> ❑ LIFTSTATION SRE TYPEOFPUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> qK LEACH LINES IL LEACHING CHAMBERS JO- - #OF LINES �_ LENGTH OF LINES 4d P R <br /> DISTANCE TO NEAREST WELL 1O5', R FOUNDATION Is" R PROPERTY LINE � R <br /> ❑ FILTER BED WIDTH ft LENGTH R OEPTH R <br /> DISTANCETONEARE:T WELL R FOUNDATION f! PROPERTYLINF R <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE it <br /> I ❑ SUMPS WOTH R LENGTH ft DEPTH R <br /> T DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE N <br /> I ❑ DISPOSAL PONDS WIDTH ft LEIJGM R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> SEEPAGE PITS NUMBER I WIDTH ft DEPTH'gj R <br /> DISTANCETONEAREST WELL (LIS" ft FOUNDATION SO R PROPERTY UNE SD• R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> MINIMUM 4%OUR VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7897 <br /> =11D <br /> TITLE L=14& DATE <br /> y <br /> (Q .�_ _-- <br /> APdiuBon AecepWO 8 Data •Area ax�+®YlClpgea ID#jLir�F L9 <br /> �MALTX DE]ARiYFM <br /> Final Inspection B Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De of 3 Ft PWS/ rnp Solt Cha acter: <br /> COMMENTS �(� L17T ¢Lbw " +t/�ilZy lg3 4L;0f477L 20` <br /> Sl,H6// «T��G/!e'G�— /�r/ �'4`Jlk's7-J '11i4ch.• �i-7.1.7r7� <br /> PE 8C RIC Amount PemliU Invdca# PermitlD# <br /> in <br /> COOe DFO B Cash Reml Dab Sarviee oast# <br /> I I � ii n zn I <br /> I <br /> a2-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> WI/TO <br />