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1.01 A.ri1i.J -c0a j'j <br /> ONSITE WASTEWATFR TREATMENT SYSTEM PERMIT ^ <br /> SANJOAQUIN cUvN'rY ENVIRONMI:NI'AI.IWALl11 DP.PAR'I'MENr -104E W1aO:N Avr..-T"1:1.-NON'PION CA 9' '11914611-3420 <br /> NON-REFUNDABLE PERMIT CALL( 697 FOR INSPECTIONS EXPIRES I VEAR FtnnE ISSUED <br /> J(OIAUONFSC / C11'V/LIP /� n N <br /> CROSSSTREEI' ?I YI1� I1?nra}+ APPI O �D-0c/ PAR(:ELSIr.E I�(Lj%j� (Qn <br /> &Kd <br /> OWNERNAME /y'j��y'O rl1-( -e �/.PHONE <br /> � <br /> OWNERADDAM P�IIJN.' �AJW_l PU CITY/STAtiJZIP IA1!r ll� /JQPC/ <br /> CONTRACTOR ' <br /> 11`u*JF / PHONE 3/-j7D/ <br /> CONTRACTORADDRESS M Ib -\ Cl11LQCIT'1'/SrATl. P ari <br /> LICENSE ❑C42 ❑C-76 OTHER NUMBER E%PIRATION DATE O <br /> WATERTABLEDEPTH: B GEOGRAPHICALINFORMATION: Coordinate! X Y <br /> PERCTEST(S) NUMBER a LAND USE APPLICATIONS O <br /> TYPE OF WORK: ❑ NEWINSTALLATON ❑ REPAIR/AmmTION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BERROOMB: NUMBER OF EMPLOYEES: O <br /> ❑ SEPTIC TANK TVPFJMFG CAPACITY gal ROF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal R OF COMPARTMENTS <br /> ❑ PIRG TX PLANT DISANCETONEAREST: WELL R FOUNDATION R PROPERTY LINE It <br /> ❑ LIFFSTATION Stu TYPEGFPUMP ❑ SAND OIL SEPARATOR(ENcLoEEDSISTENO <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS NOF LINES LENGTH OF LINES ❑ `(7\\_ <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH fl <br /> DISTANCE III NEARPSr WELL Il FOUNDATION A PROPERTY LINE R <br /> ❑ MOUNDED Wirt R LENGTH R DEPTH ft <br /> DWTANCETO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS worst R LENGTH Il DEPTD ft <br /> DISTANCE TO NFAREsT WELL R FOUNDATION R PROPERTY LINT: A <br /> ❑ DISPOSAL PONDS WIMII ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> Cl SEEPAGE PITS WIDTH A LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 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 JOAQUIN COUNTY. <br /> �1E (VMINIMUM E4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL I?09193)-7697 <br /> SIGNED • �LI���1� TITLE LC[�(T/V12Y DATE . GIUY- <br /> OJ <br /> anne <br /> i 1 <br /> 04 IMF— <br /> V l( <br /> A <br /> DEPARTMENT U. ON --TT <br /> Application Accepted By ele Area Employee IDpJ J(O[� 4/�� <br /> FinallmpecHon By Date �/ 11SPECIALPERMIT-APProvcd by j <br /> CM1uncler of Sollm cry 1: PIUSump Soil Clurulrr:__ <br /> COMMENTS �- <br /> J _ <br /> PE SC Received Che<kNl AnwuM DRIB Permlu HorsierN Perndt lDN <br /> Code Info B ash Remitted ServkeR ueslp <br /> r BD X35 03 <br /> tl'0I'WI ONSITE WASTEWATER PERMIT <br />