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ONSITE WASTEWATER TREATMENT SYSTEM PERMIi /�A w/�� <br /> SAN JOAQUIN CouNTY ENVIRONMENTAL HEALTH DF.PARTME-0 304E WEBER AVE-3"FL-STOCK"1'p l <br /> go <br /> NON-REFUNDABLV �rMyIT nCALL 209 9$3-7697 FOR INSPECTIONSEXPIRES I YEAR FROM DATE ISSUED <br /> ^ <br /> JOB ADDRESS _Cdr/ l S�(.T„�G _ L K4, �J CITY/ZIP <br /> CROSS S I'REET //U'_ ,V'� 1�- APN F. PARCEL SIZE <br /> OWNER NAME <br /> OWER ADDRESS _.. % _ CITY/STATFJZIP <br /> CONTRACTOR Y ^•�/ L/x PHONE <br /> CONTRACTOR ADUKESS CITY/STA'ITJZIY <br /> LICENSE (;-02 1.1 C-36 OTPER _ NUMBER EXPIRATION DATE <br /> WATFR TA I.F.DEPTH: _ it GEOGRAPHICAL INFORMATION: Coordinates X <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#_ <br /> TYPE OF WORK: ❑ NEW INSTALLATION _ REPAIWADDIITON ❑ ENGINEER DESIGNED/ALTERVA7'rvEq 1a <br /> ❑ REPLACEMENT ❑ DEsrituCTION \i <br /> INSTALLATION WILL SERVE: RESIDENCE L3 COMMERCIAL L3 OTHER <br /> r_ <br /> j NUMBF.ROFLIVINOI.NI'1'$: NUMBER OF REDROOMS: NUMBEROFEMPLOYEES: Q <br /> ❑ SEPTICTANK TYPE/MFG _ CAPACIII gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPLIMFO _ CAPACITY _ _ _ gal #OFCOMPARTMENTS <br /> ❑ PKC TX;FLANT DISTANCE TO NEAREST: WELL fl FOUNDATION R PROPERTY LINE fl U, <br /> ❑ LIFT- "fR N Slit; TYPE OF PuVH, ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEM) 1 <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES / LENGTH OF LINES ! fl <br /> DIS DANCE TO NF.ARF.ST WELL C _ R FUCNDATION (T�_R PROPERTY LINE ft <br /> ❑ F'ILIERHFD WIDTH R LENGTH fl DFPItI ft <br /> DISTANL'EIO NEAREST WF.1.1, R FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH it LENGTH _ R DEPTH <br /> DISTANCE TO NEAREST WELT. R FOUNDATION _R PROPERTY LINE_ R <br /> ❑ SUMPS WIDTH 9_R LENGTH '/Xr'- R DEPIH�/a R <br /> DISTANCE,TO NEAREST WELL R FOUNDAHON R PROPERTY LINE _ R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH R” <br /> DISTANCE:TO NEAREST WFIJ. R FOUNDATION R PROPERTY I.rNE it <br /> ❑ SEEPAGE PITS NUMBER ___WIDTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PKOPEKI'Y LINE Il <br /> I HEREBY CERTIFY THAT 1 HAVE:PREPARED'I HIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> Y. f.%I�MltjM 24 HOOLL}t DVANCE NOI ICE REQUIRED[-OR INSPEC'1 IONS-PLEASE CALL(209)953-7697 <br /> SIGNED—z�IL �S •fITLE �._ (. DAFE 5 -T� <br /> I <br /> IL <br /> LIN� t i <br /> i <br /> V <br /> F O <br /> N <br /> DEPARTMENT(jKE O LY <br /> •- —Application Accepted-By - _ Date- Area. ..E lovrr-1D# <br /> Final Inspection By Date �oC-'22,VS` C1SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS eO - JV5- W90126 A t�a S tCJ> <br /> AnDD I. `T - :1A m-cwt5` 4 - ;Ay/zAN6 <br /> PE SC Received Chmk#/ Amount k Invoice# Permit ID# <br /> Code INI'O By ash Remitted Service Request# <br /> 32-02-001 ONSITE WASTEWATER PERMIT <br /> I L22/2003 <br />