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3 2 V' <br />_7 <br />mum <br /> ohm <br />- - - <br />EMI= lat.= <br /> :ow ArM/' <br />Character of Soil to De of 3 F <br />716Nttli+olIFI .apocim <br />-Pq <br />12 CO <br />cm! I <br />..111111. <br />CA <br />SI <br />oUS <br />DEPARTMENT.UEE— <br />Tate 67_4 Area Employee ID# If S , <br />Pit/ <br />et#7,,..tes te <br />Application Accepted By <br />Final Inspection By El SPECIAL PERMIT - Approved by <br />mp Soil Character: <br />we. <br />Aj <br />5 <br />11, - <br />Alf/' ) <br />COMMENTS IL <br />4 <br />\,2729" ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3" FL - SroacroN CA 95202 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT <br />CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS (.fl 1 1) U•.) V" to, kV' Errvizi7 p‘c.. y C -Z1 <br />CROSS STREET C\r:k R•A • A.:3m \ <br />APN aLl /121M,ARcELsizELI•c; ACITt <br />1) OWNER NAME PHON n -3_,,S-41•67..:1 <br />5,7q OwriEn ADDRESS,, \gA C\7\--kkkty- FAY-A <;\ CITY/STATE <br />CONTRACTOR 0 t4 At co. <br />PHONE <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE 0 C-42 LI C-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: C-) ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # BUILDING PERMIT # C 1:5 (7' LAND USE APPLICATION <br />TYPE OF WORK: <br />NEW INSTALLATION U REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT CI DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: <br /> <br />El RESIDENCE 0 COMMERCIAL <br />OTHER <br /> <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />ia SEPTIC TANK <br />TypErmpa P iod <br />CAPACITY I 20 0 <br />Sal <br /> <br />OF COMPARTMENTS 2 <br />GREASE TRAP TYPE/MFG <br />CAPACITY gal <br />OF COMPARTMENTS <br />PKG TX PLANT DISTANCE TO NEAREST: WELL _471 ft FOUNDATION It PROPERTY LINE <br />LIFT STATION SIZE TYPE OF PUMP <br /> <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES (ii LEACHING CHAMBERS Etio t4 AI; 2 er 34 # OF LINES 3 LENGTH OF LINES /00S ft <br />DISTANCE TO NEAREST WELL _/(L 11 FOUNDATION / e ft PROPERTY LINE < ft <br />CI FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION Fl PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION Ii PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS 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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PI.F.ASE CALL (209)953-7647 <br />SIGNED \<\:. I \ TITLE C DATE ) -NY" :-Ir) <br />ov <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />(Check#1.--" Amount <br />Remitted Date Permit/ <br />Service Rsuest # Invoice # Permit ID# Cash <br />fzi:7 , I I -7 116- 3947 175-C ,,f2tIol:, S K 00 +1 70 G.9 <br />42-02-001 ONSITE WASTEWATER PERMIT <br />12/22/2003 <br />In <br />(7-1: