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ONL�ITE WASTEWATER TPEATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNT Y E NVIRONIMENTAL HEAL TH Dr-rARTMFNT 1868 E.HAZELTON AVENUE•S?OCKTON CA 95205-(2091068-3'a42 <br /> 0 <br /> _NON-REFUN P - MIT L(209 95 762Z FOR 1_NSPECT/ONS EX RES 1 YEA FROM DATE ISSUED <br /> CIT <br /> �— - <br /> JOR ADORES6 vo - <br /> CROSSSTREE' OF lvr PARCEL SIZE - <br /> OWNER NAMt N! LA-j(_SAir-,A� a"-J <br /> FL ^ ,nP PHONE. <br /> OWNER ADDRESS l� • {J CITY/STATE/ZIP <br /> CONTRACTOR D!,APfIONE i 9 6� <br /> COhITRACTDR ADDRE-. O ` �' w o v "(114-_ CfTY/STATE/ZtP q732 <br /> r <br /> S <br /> LICENSE *42 C-36 OTHEk A NUMBCk O5 <br /> 11 EXPIRATION DATE <br /> WATER TABLE DEPTH: _ _ ti GkOGRAPHICAI Off-ORMATION: Coordinates X Y <br /> PERC TESTs FU9 IL6ING PERMIT# �,Q L _ o _ LAND USE APPLICATION# <br /> TYPE OF WORK. NEwINSTALLATION x REPAIRIADOITION ENGINEER DESIGNED/AIL TFRNA TIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: x RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: _ -_ NUMBER OF BE UROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPFJMFG ;.L CAPACITY ^/ '^/ <br /> _l . <br /> gal l OF COMPA ITME]JIc – - <br /> (7 GREASE TRAP TYPLIMF,; _ CAPACITY gal #OFCOMPARI"MENI! : <br /> DISTANCE TO NEAREST: WF.LL r, It FOUNDATION_ K PROPERTY LINE t <br /> ❑ LIFT STATION SIZE TYPE OF PUMP J PKG TX PLANT O SAND OIL SEPARATOR IENCLOSEU SYSTFLI) <br /> ❑ LEACH LINFS LL ACHING CHAMBERS #OF LINES LENGTH OF LNI.:, R <br /> DISTANCE TO NEARESI WELL It IUUNDATION It PFh7PFR7'+LiNF <br /> ❑ FILTER BED WIDTH _ _ __ It LENGTH _ tt DEPTH <br /> DISTANCE 10 NEAREST WELL _ it FOUNDAIION _ ft PROPERTY ONE <br /> ❑ MOUNDED WIDTH It LENGTH It DEPTH t! <br /> DISTANCE 10 NEAREST WELL It f OUNDATION $ PROPERTY LINE fl <br /> -I SUMPS WIDTH It LENGT44 ft DEPTH ft <br /> DIST"ANCETo NEAIM SI WELL It I1'JNOArION It PROPERTY LINE <br /> int DISPOSAL PONDS WIptH It LENGTH ft DEPTH tt <br /> DISTANCE to NEAREST Wf_L!. It F,,UNDATtON It PROPERTYUNE tt <br /> l l SEEPAGE PITS NUMBER WIDTH _ _ _fi DEPTH __ __.__ 11 <br /> DISTANCE TU NEARESI WELL tl I JUNDATION 1`1 PROPERIY Link <br /> i1EREBY CERTIFY THAT 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 /> C/' <br /> 11 0&f?%4VAWjF <br /> v.WRCWE0U1RED FOR INJPJMIM k PL ASE CALL 209 53 7697 <br /> SIGNED I t TITLE DATE <br /> - i <br /> IT- <br /> N <br /> tai <br /> – )I 'fL <br />