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" ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SME WEBER AVE-3`'FL-SEOCKTON CA 95202-(209)068-3120 <br /> NON-REFUNDABLE PERMIT CALL 309)933-7697 FOR INNPECSIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ! 1' - rvA 1 t E-. f'CJ fc r''"'!�. Crrvmv <br /> w <br /> caoLS SraeeTr�.5' AIMS <br /> OWNER NAME J^. t C✓ 1' J�L f T,�GY ( ill c k- 1> PHONE <br /> OWNERADDRESS CITVISTATE)ZIP <br /> that COMPACTOR J(� PHONE <br /> CONTRACTOR ADDRESS l - LJ CrrvlsraT .P <br /> LICENSE ❑C42 O C-36 OTHER NUMBE0. EXPIRATION DATE <br /> Rao WATER TABLE DEPTH: R GEO MiP LINM MXMM: CooMlnvrp % Y <br /> PEBCTEST # BUILDINGPERMIT B LAND USE APPLICATION B - <br /> TYPE OFWORK: ❑ NEV'ORIALLALION KEPAI.ADDITION O ENGINEER BLOOMER 1ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DEscinu ION <br /> INSTALLATION WILL SERVE: 13 RESIDENCE El COMMERCIAL ❑ OTHu <br /> NUMBED OF LIVING UNITS: NUMBEROFBEDROOMS: NUMB80.0F EMPLOVE[S: <br /> ❑ SEPTICTANK TYPF/MFG CAPACITY Sol M OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MCAPAtTY Hill MOF COMPARTMENTS <br /> ❑ PKG TX PLANT DHTANCETONEARe .. WEER It FOUNDATION— ft PROPERTY LINE it <br /> ❑ LIFT STATION SITE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSVOrEM) <br /> ❑ LEACH LINES ❑ LEACHINGCHAMBER9 #M'LINEB LENGTH OF LINES fl <br /> DIETANCETONEAREST WELL R FOUNDATION R PROPERTY LME fl <br /> ❑ FILTER BED WIDTH 0 LENGTH ft DEPTH fl <br /> DISTANCETONEAREBT RRLL ft FOUNDATION B PROPERTY LME It <br /> ❑ MOUNDED W. fl LEXOTII fl DFJTN ft <br /> DURANCETONEARLST WELL R FOUNDATION ft PROFERTV LINE fl <br /> ❑ SUMPS win. R LENGTH ft DEPTH ft <br /> DUETANCETO NRAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WHYFH ft LENGTH a DEPTH ft <br /> _ DISTANCE TO NEAREST WEL, ft FOUNDATION ft PROPERTY LME fl <br /> ❑ SEEPAGE PITS NUMBER W. fl DIM ft <br /> DISEANCEMNEAR83T WELL ft FOUNDATION R HtOPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES.STATE LAM AND RULES AND REGULATIONS OF BAN JOAQUIN COUNTY. <br /> M IN I MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 12091 Q53-7,V7 <br /> SIGNED 1. I " - - - TITLE DATE At <br /> iB n <br /> 7 7f 7 <br /> NV R <br /> P E <br /> J DEPARTMENT USE QNLY <br /> Application Accepted By "- F=— tiA '✓ OBM � , A. EmplDyplDa VO 'j <br /> FinaletiBR by <br /> Dale [3 SPECIAL PERMIT-Approved by J <br /> Characterc aof Soil 10 RpH of]IN: PIUSump Bell Character! <br /> COMMENTS <br /> PE SC RpHvW c...._GpECW- Amount p� PermN/ Invoke# YarmB IDN <br /> Code Inw-f I �B/' r GW Rema4d SerNce ERM# <br /> � - ��� <br /> ONSITE WASTEWATER PERMIT <br /> 12-02-001 <br />