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a� <br /> j ONSITE WASTEWATERTREATMENT4 EWYESSTEMER AVE �PERMIT <br /> CA95201 (209)469-3420 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEP CAENT <br /> LL 209 <br /> g3-7697 FOR INSPECTIONS EXPIRES l YEAR FROM DATE ISSUED y <br /> NON-REFUNDABLE PERMIT > CITYlZIP ° a y <br /> f <br /> FJOBADDRESS r� .rZ� (j3 PARCELS17S,l APNSS STREET _.�.. - PHONEiER NAMECITY13TA1'F/ZIP <br /> NER ADDRESS PHONE <br /> CONTRACTOR <br /> CM MATEfZIP <br /> CON'TRAGTOR ADDRESS O I• <br /> NUMBER <br /> EXPIRATION DATE � O <br /> LICENSE ❑C-42 ❑C•36 OTHER — Y��_ <br /> YVAT'k:RTABLEDEPTH: h GEOGRAPHICAL INFORMATION: Coordinates ;'( I� <br /> BUILDING PERMIT# LAND USE APPLICATION# V <br /> ❑ PERT TEST # RgpA1WADDITION ❑ ENGINEER DESIGNED IALTERNATIYE <br /> TYPE OF WORK: D NEW REPLACEMENT <br /> INSTALLATION ❑ DESTRUCTION <br /> ❑ Rc.PLACEMENT ❑ OTuER <br /> r� C) COMMERCIAL <br /> INSTALLATION WILL SERVE: P RESIDENCE NUMBER OF BEDROOMS: NUMBEROF EMPLOYEES: <br /> NUMBER OF LIVING UNITS!, gal #OF COb pARTMENTS <br /> CAPACITY <br /> ❑ SEPTIC TANK TYPPJMIl <br /> CAPACITY gal #OF COMPARTMENTS.— <br /> L] <br /> OMPARTMENTS,❑ GREASE TRAP TYPE MFG ft PROPERTY LINE - ft <br /> ft FOUNDATION <br /> DATION <br /> TX PLANT DISTANCE TO NEAREST: WELL_ ---- ❑ SAND OIL SEPARATOR(ENCLOSED SYSTFJH) <br /> E3 LIFT STATION SIZE TYPE OF P _ <br /> Y <br /> LINES LENGTH OF LINES ft r <br /> �of <br /> ❑ LEACH LINES 1 LEACHINGCH g FOUNDATIONS—ft POLOPERTY LME_____rR <br /> DISTANCE To NEAREST WELL DEPTH Ll / ft <br /> FILTER BED WIDTH /—.5- eNGTii <br /> fl L <br /> _fl FOUNDATION �_ —ft PROPERTY LINE_—sem---ft <br /> D13rANCETr1NEAREST WELL <br /> W 11 ft ft <br /> ❑ MOUNDED WIDTH� III LENGTH ft DEPTH PROPERTY LINE ft <br /> DISTANC7t TO NEAREST WELL ft FOUNDATION ft <br /> fl DEPTH <br /> ❑ SUMPS WIDTH _ft LENGTH R PROPERTY LINE ft <br /> DWANCE TO NEARM WELL fl }IX:NDATWN�-�-- Jft <br /> ft DEPTH <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH ft PROPERTY LINE R <br /> DISTANCE TO NEAREST WELL. 1t FOUNDATION�— ft <br /> ft DEPTH <br /> C3SEEPAGE PITS Nimsom WIDTH <br /> DISTANCE TT)NEAREST' %ELL <br /> fl FOUN'AA'Tlt)N _ fl PROPERTY UNE�---- <br /> I NEREBI'CERTIFY THAT I ORDI ANCE&STATE LAWS AND RUAND THE WORK WILL BE DONE 1-4 ACCORDANCELE AES ND REGULATIONS OF SAN JOAQUINN COUNTYW tTT(SAN JOAQLIN COUNTY' <br /> 1607 <br /> NIMUAt HOUR ADVANCE NOTICE REQIiiRF.P FOR INSPECTIONS-PI-F�.A�F•CALL 1209)9tz DAT w <br /> TITLES- DATE. <br /> SIGNED <br /> N <br /> I � <br /> .D ARTMENt 'E ONl <br /> Date Area Employee ID# <br /> Appitcstion Accopted By Date 7 D [3 SPECIAL PERMIT-Approved by <br /> 3 <br /> Final inspection By PI ump Sell Character: <br /> Character of Soil to of 3 Ft: <br /> COMMENTS <br /> r <br /> Amount PermfU Irtvoiec# perrnit IDN <br /> PE SC Received Chet Dale Service R uest# <br /> Code INFO By h Remitted <br /> i ONSITE WASTEWATER PERMIT <br /> 42.02.001 <br />