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"ONSITE WAS ;WATER TREATMEN�_'YST VITERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEgLTHk`��.ARTMENT w.-104 E+WEBER R.s -Jk FL-STOCI(TON CA 95202 - (204)46$-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIR `'y , F T SSUED <br /> JOB ADDRESS _ , I'Z <br /> ` CITY/ZIP I <br /> y� .� t+1 <br /> CROSS STREET '" 5 APN 055— —77 ?35' PARCEL SIZE 14! /] C <br /> T Y a <br /> OWNERNAME .>,�' ,D-r• - - ,r L 4 <br /> ONE <br /> OWNER ADDRESS yJ l li � 1 Z - CItYISTATE/ZIP - <br /> CONTRACTORfie roC PHONE <br /> CONTRACTOR ADDRESS V _ CITY/STATE/ZIP <br /> (/tsln <br /> LICENSE ❑C-42 ❑C-36 OTHER <br /> - NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X V <br /> PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED IALT$RNATIVE <br /> Q REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Ii ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: r N.UMBER'OF-EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG: CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG'� - CAPACITY gal #pFCOM PARTMENT5 <br /> ❑ PfKC.TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ ..LI]?T'STATION SIZE TYPE OF PUMP ❑ 'SAND OIL SEPARATOR(ENCLOSED SYSTEM) i <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES g <br /> DISTANCE TO NEAREST WELL ft, FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH I! $ LENGTH ^_+ <br /> - R' DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> ft PROPERTY LINE lt. •:j-aE;. <br /> ❑ MOUNDED WIDTH l ft LENGTH ft DEPTH ft f <br /> k <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE—,, <br /> U SUMPS WIDTH. .. — <br /> ft LENGTH ft DEPTH '1ft=,, _+ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE - ft <br /> DISPOSAL PONDS WmTH ! - -ft LENGTH ft DEPTH ,`.ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ' ft PROPERTY LINE <br /> 0 SEEPAGE PITS WIDTH, ft LENGTH ft DEPTH ftp <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> �ft" <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION-AND THE WORK WILL BE DOZE I'N ACCORDANCE WITH SAN JOAQUIN COUNTYORII)INA'NCES, <br /> II STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM,24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED <r ` ' <br /> TITLE DATE <br /> 'TT MtYl <br />/ `. E <br /> -- <br /> 7 <br /> A 'd 'AQ,IN I { <br /> P AT E T <br /> 1 DEPARTMENT VSE NLY 5 <br /> 3 CT7 <br /> flllcWti" ccePArea mployee 1D#iI9ec on B­ _Yrm <br /> Date �� 6.5., © SPECIAL PERMIT'-Approved by r <br /> CharaeterofSoil epth of Ft: Pit/Sump Soil Character': <br /> COMMENTS o cz�z-c t `GI , ,� /' 1 <br /> PE SC Received C ec Amount <br /> Permit/ <br /> Code INFO Cash Remitted D le Service Re uest# Invoice# Permit ZDQ <br /> 2- s 3 2_00 X 00 !� <br /> i <br /> 42-01'001 <br /> 12/2/02 ONSITE WASTEWATER PERMIT <br /> c <br />