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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY E,411IRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"FL-NIFOCKTON CA 95202-(209)469-3420 <br /> NON-REPUNDA L PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> n4C 15 CITYIZA P <br /> JOBADDRESS C' aAaT <br /> w <br /> CRO.SSSTREET O1 AP105t'52O-C6 PARCEL SIZE 1 *3 " D <br /> 0 <br /> 0 <br /> OWNER NAME CIOlK � <br /> PHONE J ���' f <br /> OWNER ADDRESS X CITY/ST'ATE,7.I%1 -"TQC [5*9—6 f <br /> • CONTRACTOR IC/1l AS ! C PHONE <br /> 466--9607 <br /> CONTRACTOR ADDR CiTY'IST'A'I'El7A <br /> LICENSE C-42 O C-36 OTHER NIntHEx ExPtRA-nON DATE <br /> WATER TABLE DEPTH: fl GEOGRAPIIICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST 4 BUILDING PERMIT# LAND USE APPLICATION#_ <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEERDESICNED/ALTER.NATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBERROFiB�EDDRROOO�MS; NUMBER OF EMPLOYEES: <br /> 1N( SEPTIC TANK TYPE/MFG `L (DC L-1VJlJCAPACITY 2400 Sal 710FCOMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY, gal #DFCOMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL^� ft FOL?IDATION 60 ft PROPERTY LINE ice ft <br /> Y't LIFT STATION SIzz 11 TYPE OF PIMPL.i3{trl Vb� A-� Q SAND OIL SEPARATOR(EN..B.B SYSTEM) <br /> 94 LEACH LINES Y LEACHING CHAMBE #OF LCNEs LENGTH OF LINES 5 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C <br /> ❑ FILTER BED WIDTH ft LENGTH _..... _ft DEPTH It L� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH _.__ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY UNE ft F <br /> ❑ SUMPS WIDTH ft LENG TH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELIft FOU.'' A710N ft PROPERTY LINE fI <br /> 1 SEEPAGE PITS NUMBER �W'.". i/ �, ft DEPIx 5ft <br /> DISTANCE TO NEAREST WELL- ft FOUNDATION I OO It PROPERTY LINE 0 ft <br /> 1 HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY j <br /> ORDINANCES,STATE LAWS AND RULES AND REGLLATIONS OF SAN JOAQUIN COUNTY. / <br /> r`f^lJ�,�(���-(/�/'J MI.1�{JIM U t A v N E NOTICE REQUIRED FOR INS ON�S�-PLE S CAA LL(L(?09)953.7697 <br /> TITLI �N`e�t J 1 DAT£ <br /> fa <br /> I V11 <br /> ? / <br /> oca <br /> I <br /> fl <br /> J A UI <br /> MP 1 A <br /> DEPARTMENT USE I ONLYc{ <br /> Appllcatlo a Accepted B / -�— "Date.._lz�l Area 212- Employee ID# ✓36� �� <br /> Final Inspection By c.ldi -/ r Pace ❑ SPECIAL PERMIT-Approved bx <br /> Character of Soil to Depth of Ft: PiUSump Soil Character: <br /> COMMENTS 0" L-oT o F eco P� �lis - y�/C 2�sf l Ci�ff�?2 3 f �i esr ti _ - �'av <br /> /AJ✓ 4 "USso� ' B�-r-w. /-r .t��s �u.r<.OF'-n.e_ au — <br /> PE SC Received h Annuat Permit! -e it 1 <br /> Code INFO By Cast Remlttcd ate Service Re uest# <br /> v <br /> 12,2211003 <br />