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130 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMITpp <br /> .1TS4N O OI11N C(Yi VIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER Ave -3"FL-SroGlcrp` CA 20'2'.= (309,)68 120 <br /> NON-REFUNDABLE PERMIT <br /> CALL(209)953-7697 FOR INSPECTIONS <br /> JOB ADDRESS <br /> EXPIRES 1 YEAR FROM'DATE,ISSUED <br /> : � �� ii <br /> _ CITY/ZIP <br /> 1-0 eREET f �I ) = t I��} r2_0 APN r�j <br /> OWNER NAME �l <br /> �J (� Y� <br /> �. — ``f Z�!- 1�� PARCEL SIZE <br /> I `i � C) <br /> -7342�j PHONE ! t+ <br /> OWNER ADDRESS ' '-I [56 _ -fir` +/ C/�a <br /> C1T]'I$TATEIZlP ��- <br /> f CONTRACTOR � {' t- ^` } <br /> �r �J �+ vC PHONE/ Tvild <br /> CONTRACTOR ADDRESS 1 Jp�l `�] <br /> - 1�'" CITY/STATE/ZIP ;-���.[�,1(_�1 <br /> LICENSE C-42 ❑C-36 OTHER ` � �� NUMBER � , � J <br /> WATER TABLE DEPTH: 11 <br /> EXPIRATION DATE <br /> R GEOGRAPHICAL INFORMATION: Coordinates X <br /> Y <br /> ❑ PERC TEST[S) NUMB);R <br /> LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION <br /> L3 REPLACEMENT X.-REPAIR/ADDITION`- <br /> Y11 ❑ ENGINEERDESICNED/ALTERNATIVE <br />+ ❑ DESTRUCTION <br /> IF INSTALLATION WILL SERVE: 12KRESIDENCE <br /> ❑ COMMERCIAL � ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> f NUMBER OF EMPLOYEE$: <br /> ❑ SEPTIC TANK TYPE/MFG �e <br /> ❑ <br /> GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL <br /> ft FOUNDATION ft PROPERTY LINE <br /> ❑ LIFT STATIONft ? <br />' SIZE TYPE OF PUMP r ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> `A—LEACH.LINES . $..LEACHING CHAMBERS [ ) ) #of LINES i LENGTH of L1NE540- I <br /> DISTANCE TO NEAREST WELL �F r ! ft it I <br /> ft FOUNDATION <br /> ❑ � ��"'� I- <br /> FILTER BED WIDTH ft 1[ <br /> ft LENGTH f[ DEPTH PROPERTY LINE <br /> DISTANCE TO NEAREST WELLft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH <br /> ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> ❑ SUMPS h PROPERTY LINE ft <br /> WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft <br /> ft FOUNDATION ft PROPERTY LINE ft- <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH <br /> ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> ft PROPERTY LINE ft <br /> SEEPAGE PIT �� 'WIDTH _ ft LENGTH <br /> ftr DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION �h f , <br /> -. - � f[ PROPERTY LINE i.,d <br /> I <br /> I HEREBY CERTIFYTHAT 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 /> JCR -;jIN <br /> _6 �ryJJIIJJ]1� R ANCE NOTICE REQUIRED FOR N TIONS— L A5E CALL{204)953-7697SIGNED TITL i <br /> DATE, L !!! <br /> .l <br /> 0r <br /> it I� <br /> r i <br /> T <br /> -r <br /> 12 iD <br /> httpa/Webster/servlet/com.esn-emmap.Esr'map?ServiceName=Sjcovervlew& orm=True&... 4% %2 <br />