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A <br /> � IoW <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> :CAN JOAQUIN COUNTY EN%'IRONMENT A L HEA 1,1-H DLYAHT:M LNI 304 E WEBER AVE-3"'FL-S I'OC'NTOV CA 95202 - (I09)4611-3420 <br /> NON-REFUNDABLE PERMIT CA L1,42,09)953-7697 Fo INSPECTIONS E PIRE 1 YEAR FROM DATE ISSUED <br /> / S J <br /> JOB ADDRESS CfTYIZIP _ <br /> Ae > <br /> CROSS STRCET APN �j — O� Q PARCCL SIZE p <br /> OWNER NANAF. PHONF <br /> OWNER ADDRESS Cr.'1STATEIZIP <br /> CONTRACTOR — C— <br /> PHONE <br /> CONTRACTOR ADDRESS �/ CrrVISTATFJZIP <br /> LICENSE -42 ❑C-36 OIHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH:_ � R GEOCRAPHICAL INFORMATION: Coordinates X <br /> ❑ PERC TEST(S) Numm, LAND USE APPLICATION 4 <br /> TYPE OF WORK: ❑ NEW INSTALLATION AL REPAIIUADDrc1ON ❑ ENGINLER DL SIGNED/ALTERNATIVE <br /> ❑ REPLACLMEV"F ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER_ <br /> II NUMBER OF LIVING UVITB: N UMBER OF BEDROOMS: NUMREROFENPLOYEES: __ _ <br /> ❑ SEPTIC TANK TYPE7MFG_ CAPACITY gel k OF COMPARTMENTS n <br /> ❑ GREASE TRAP TYPUMFG ._ CAPACITY gal k OF COMPARTMENTS 1v^j <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION Slzr —--TYPE OF PUMP/ ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES r LEACHING CHAMBERS J p OF LINES �_ LENGTH OF LINES T� R `x <br /> DISTANCE TO NEAREST WILL O R FOUNDATION ' R PROPERTY LINE //57777/ R J <br /> ❑ FILTER RED WIDTH _ R LENGTH_ _R DEPTH R f <br /> DISTANCETONF.ARCST WELL <br /> -� R FOUNDATION- J R R PROPEFYLwEPAYtiirNi - It <br /> E3 MOUNDED MOUNDED WIDTH LENGTH R DEPTH RECEIVED It <br /> DISTANCETONEAREsr WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH _ It DEPTH nr.Tft <br /> DISTANCETO NLARs_5T WELL R FOUNDATION_ R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH_ _ __ _ __R DEPTH SAN JOAQUIN <br /> ft <br /> DISTANCE TO NEAREST WELL � R FOUNDATION R PROPERYI <br /> 'IYIINVI : I u, ,.I.hI iH f?IVISIOR <br /> SEEPAGE PITS WIDTx 3 ft L"1'0 ft DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNDATION /�R PROPERTY LINE / R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIN APPLICATION AND THE WORK.WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGUI AT1ONS OF SAN JOAQUIN COUNTY. <br /> r NIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPE/C—TIIONS-PLEASE CALL(20099)953-7697 <br /> SIGNED cJ /C6 TITLE. /'!/ '!%L� DATE <br /> 7 <br /> V IV <br /> it <br /> DCPA EONL <br /> Appllcdbo Accepted P1 _ e / <br /> Arca Employee[Dii S _ <br /> Final Inspection By. Date ❑ SPEQ1l.PERMIT-Approved by <br /> Character of Soil 13."h ora Ft: PWSump Soil Character. d i�si fTi <br /> COMMENTS <br /> dL <br /> PESC Received hoe Amount Dah Permit/ Invoke K Permit IDA <br /> Code INFO B Cash Reml Ued e Service Re utas N <br /> e2-01-DDI <br /> 12/2,02 ONSITE WASTEWATER PERMIT <br />