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NA TER TABI E. DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICA l'ION # <br />INSTALLATION WILL SERVE: El RESIDENCE. <br />NUMBER OF LIVING UNITS: <br />CoMMERCIAL U 01 HER <br />NL SIDER OF BEDROOMS: NUMBER or EMPLOYEES: <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AvE - FL - STocicroN CA 95202 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CAI,I, (209) 953-7697 1.()B 1%srEcTioNs EXPIRES I YEAR FROM DATE ISSUED <br />?--ckos--cl CITY/ZIP t•-• PL4a_9_(zZjg__ <br />A PN 0 —.5 -2.470 --- 0 3 PARCEL SIZE ..l'... S A—C... <br />0 <br />PHONE <br />CiTY/STATErliP <br />PHONE -4(404- <br />CONTRACTOR ADDRESS C try/STATE/ZIP <br />LICENSE C-42 (7- )6 OTHER N MUER EXPIRATION DATE <br />TYPE OF WORK: --I NEw INSTALLATION 7.3 REPAIR/ADDITION J ENGINEER DEsIGNED/ALTERNAE Iv r. <br />—I REPLACEMENT U DESETtuctioN <br />SEPTIC TANK TYPE/MEG CAPACITY gal OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />JOB ADDRESS <br />CROSS STREET <br />OwNER NAME. <br />OWNER ADDRESS <br />CONTRACTOR <br />1 CZ, Z; <br />V•-• \L-Q <br />scc 4_0/, ecAn 0 :SSIHOGV 31IS 1,04 traiM ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />PNG TX PLAN DISTANCE TO NEAREST: WEI : ft Fat 'NDATION fl PROPERTY LINE Li <br />LIFT STATION TYPE OF PL MP CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES U LEACHING CHAMBERS n OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ii PROPERTY LINE ft <br />-I FILTER BED WIDTH ft LENGTH 11 DEP:0 ft, <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />NIOUNDED WIDTH ft LENGTH It DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINT fi. <br />C,) DISPOSAL PONIES WIDTH ft LENGTH ft DEPTH , ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION II PROPERTY LINE ft <br />El SEEPAGE PITS NumBER WIDTH II DEMI ... ti ._ <br />Dist- A NCE TO NEAREST WELL ft FOUNDATION ft PROPER I Y LINE ft <br />I HEREBN CERTIFY THAT I HA \ I. PREPARED THIS APPLICATION AND I HE WORK WILL DE DONE IN ACCORDANCE ss III SAN JOAQI IN COL NTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTS -. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR iNspEci IONS - PLEASE CAE (209) kE53-7697 • <br />DATE Id t.C• <br />1. I <br />II <br />It <br />i <br />U. <br />. <br />II <br />illt .• N <br />i Noisi , <br />SI GN "riTI,E