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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUER COUNTY ENVIRONMENTAL HEALTH DEPART'MFM 3WEWEBERAVE-3"FL-STDCXT0N CA 95202 -(209)461 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISNUEp <br /> JOB ADDRESS 11�`'�JT J F�- '�'vR 1�4�., t:1> V1 q CITY2n i- �7 4 q`_,2 q"7�- m <br /> CROMSTREET 111,P/�A V� s .` APN f/Z 1 '� O�� 0-Z— PARCEL SIEE,�y_.,� <br /> OWNERNAME N {��)y { - n <br /> PHONE <br /> OWNERADDRESS CITYISTATFUZIP �F <br /> CONTMCFOR PHONE ��J� T _Zj <br /> CONTRACTORADOREMor <br /> LICENSE 0C4 ❑C-16 OTHER NUMBER EXPULITmiNDATEV <br /> WATER TABLE DEPTH: ft CE(UGRAPHICALLYPORMATION: ConEdInalee X Y <br /> PERC TEST p BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK:. ❑ NEWINSTALWTION ❑ REPAIRIABIHOON ❑ ENGiNCCR DPSICNED(ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCODN <br /> LNSTALLATIONWL SERVE: ❑ RTSIDENCE El COMMERCIAL OTHER <br /> NUMBE0.0F LI VIILNG UNTIS: NUMBEROPBEDROONVU NuatuROFE3IPLOVEE4: 'X3 <br /> ❑ SEPTICTANK TYPFJMFG CAPACRY PI NOFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY SAI #OFCOMPARTMENTS \ <br />..., ❑ PKG TX PLANT DISTANCETONEIREST: WELL ft FOUNDATION R PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPEOPPDMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYsPEM) <br /> O <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINEB LENGTH OP LINES.. fl <br /> DICI'ANCETONEARESF WELL—R FOUNDATION A PROPERTY LINE it <br /> ❑ FILTER BED WIUDI R LENCTx R DEPTH R <br /> DISTANCETONEARESF WELL q FWNDATNN ft PROPERTY LINE <br /> fl <br /> ❑ MOUNDED W.H.-ft LErvOTx it DEPTH It O <br /> DISTANCE TO NEAREST WFJ.L ft FOUNDATION fl PROPERTY LME q <br /> ❑ SUMPS WIDTN it LENGTH fl DEPfx R <br /> DISFANCETONEARIEST WELL R FOUNDATION fl PROPERTY LINE A 1 <br /> ❑ DISPOSAL PONDS W._ft LENOTH fl DEPTH R <br /> DIUANCETONEARFST -WELL it FOUNDATION A PROPERTY LINE - fl <br /> ❑ SEEPAGE PITS NDMB6a Wi. ft DEPTH ft <br /> DISEANCETONEARESF WELL R FOUNDATION ft PROPERTY LME 6 <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WTTH BAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND RUDD LATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24,IOUR ADVANCE NOTICE REQUIRED FORI_NS/PECTIONS-PLEASE <br /> `CALL(209)953-7697 'r <br /> SIGNED ��� _� ,f-' TITLEt! c' h RATE Y ZG c Av <br /> N <br /> R <br /> DEPARTMENT SE LV y/ <br /> Appling9n AEceDIetl BY - Date U G Ara Enlployeo lD# <br /> Final lo,ection By Data ❑ SPECIAL PERMIT-ADplove by - <br /> Chancier of Soil to Depth 01`3 ft PH/Sump Soll Ch4nete,: <br /> COMMENTS <br /> PE SC ReaiveA C6ecMX Aimuol PermiD <br /> Cofle IwaD B mh ReMbd paw SerWceR ueal# IRwK:e# PerMtlDp <br /> U522 r;7f to r -'[ %�'�1 lVSc\:% .J i1(Lj/'.S.'� ✓`�' <br /> 42-0LWI ONSOE WASTEWATER PERMIT <br /> 1=/ 2003 <br />