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e <br /> ONSITE WASTEWATER TREATMENT SYSTEM PER-MU'CCQNNEP' " <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL.HEAL I DEPART MEN-1304 E WEBER AVE-3"'FL-STO KTON CA 95202 - (209)468-3020 <br /> _NON-REFUNDABLE.PERMIT CALL 209 953-7691 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /fit-pE?2— SO 7 CIY/ZIP yTGG�� 7-5, �o_ <br /> CROSS STREET M,o NIN S t _ APN <_ ��' r 6 PARCEL SIZE a <br /> �J y o <br /> OWNER NAME /C�'O`I� T�N^� ! \ r/Y t`{!X JII�O ohza `J ^7 <br /> OWNER <br /> OWNER.ADDRESS Ll Sos(y _ CFIY/STA'1'EJZIP 1{�t(��A���♦/N__1_ 33 <br /> CONTRACTOR Set\ PHONE S <br /> CONTILVCTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑('-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH:_ tt GEOGRAPHICAL INFORMATTON: Coordinates X _ Y <br /> ❑ PERC TEST # HU-- PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION O REPAIRIADDTTION ❑ ENGINF.EF.DESIGNED/ALTERNATIVE <br /> vl REPLACEMENT � DMRCC"EION G r-'7 <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERC AL ❑ OTHER <br /> NUMBEROFLIVINGUNITS[ _ , N UMBER OF BEDROOMS: ALI <br /> NUMBF.ROFEMPLpY'F:ES: _ <br /> 0'-'1EP'I IC TANK TYI'G'MF'(i �'k CO o CSR T e- CAPACITY I°T PV gal #OF COMPARTMENTS 2- <br /> 0 <br /> ❑ GREASY TRAP 'IYI'EI4FG _ CAPACITY Pal #Of COMPARTMENTS <br /> ❑ PK(;TX PLANT DIST'ANC'E FO NEAREST: WFLI ft FouNDATION J d 0 PROPERTY LINE R <br /> ❑ LIFT S ATION 817.E '1'YPF.OF PUMP ❑ SAND OIL.SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LEZGTH OF LINES ft NJ <br /> DISTANCETO NEAREST WELL R FOUNDATION R PROPERLY LINE ft <br /> 1 k <br /> CY HLEN <br /> FILTER RED WIDTH t CI'Hfl— Q DEPTH f•f Z: ^w0. -_ R C <br /> I J <br /> DISTANCE TO NEAREST WELLj e:)t '* R FOUNDATION 7—�S" (! PROPERTY LINE R <br /> MOUNDED WIDTH ft L::\GTH R DEPTH <br /> DISTANCE TO NEAREST WELL_ R FOUNDATION ft PROPERTY LINE _ jt <br /> ❑ SUMPS WinH It LCNGTII _ ft DEPTH <br /> DISI"ANCETONEAREST WF.1.1. It FOUNDATION R PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH R LENGIII R DEPTH It <br /> DISTANCE;'1'O NEAREST WELL _R FOUNDATION H PROPERTY LINE <br /> O <br /> :1 SEEPAGE PITS NCMeeR ___wlonl_ _ R DEPTI[ ft J <br /> DPWANC.F.To N EARESI' WELL l: I-GUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS.APPLICATION AND THF.WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,SI A'fE:LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> .1INIMUM 24 HOE/R t)V'Ar,(—- �OTICE RF.QUI'RED FOR INSPECTIONS PLEASE CALL t209)953-7697 <br /> SIGNED LuL .�`R���/ _ 'TITLE_ N ncr& DATE Z—,2==—OAC- <br /> .-TTTT-T <br /> E <br /> O <br /> At E N <br /> M <br /> g <br /> v 1 <br /> jL�\ <br /> • <br /> APPIlwlian Accc [cd By � D_E_PARTMEN-T�E(N�L�Y <br /> Due f/ok-, <br /> Arca Fmployu:ID <br /> Final Inspection RVrJ44Date <br /> ❑ SPECIAL.PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft; _ PIUSump Soll Character:—__ _ <br /> COMMEN 'S r?- /� :-c r vF 44;--7og2j 1�8�0A(e-�✓D <br /> PE SC Received Choc Amount Permit/ <br /> r <br /> Conare de Ingo By C <br /> h Remitted Service Re uest# Invoice# Permit IDN <br /> y LA I <br /> it 42-02-001 -- <br /> 12%22.2003 ONSITE:WASTEWATER PERMIT <br /> r_ <br />