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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AYE - 3" FL - STOCK-Ton CA 95202 - (209) 460-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 Km I NsPEcTIONS EXPIRES I YEAR FROM DATE ISSUED <br />11_02._. _t, 'i't(._:&,L)_•zAll)„D CiTY/Z4F J00 ADDRESS <br />CROSS STREET f 14 CAL4ITP U 0.-• APN .2-13 0.2-0 1 i PARCEL SITE <br />glen VN ' l'-4.Y a____ <br />Os.VNER ADDRESS R-P-K-LiLtr Cilte3abiLe IZ 0 CITYISTATE/ZIP 431121:-1.--K.Y1 <br />Pa-LS -C.' R.1 <br />CONTRACTOR ADDRESS 80744 1,-.) 13 rl--t-TA-. <br />LICENSE 0 C-42 CI C-36 OTHER NUMBER EXPIRATION DATE <br />OWNER NAME PHONE <br />CONTRACTOR <br />CITY/STATE/ZIP 7at4c,sz) <br />-37 <br />99. a? <br />INSTALLATION WILL SERVE: RESIDENCE <br />COMMERCIAL <br />NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS: <br />SEPTIC TANK TYPE/MPG E:Nc Cr/ AJ C --E_ CAPACITY <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST; WELL ft <br />SIZE TYPE OF PUMP <br />El OTHER <br />NUMBER OF EMPLOVRES: <br />4. OF COMPARTMENTS <br /># OF COMPARTMENTS <br />PROPERTY LINE ft <br />0 SAND OIL SEPARATOR (ENCLosED SYSTEM) <br />0 <br />0 <br />PKG TX PLANT <br />Lin STATION <br /> gal <br />CAPACITY gal <br />FOUNDATION ft <br />JAI4 2 <br />;AN ENORCivM.N-CAL <br />2 2P <br />00 <br />0 <br />WATER TABLE DEPTH; ft GEOGRAPHICAL INFORMATION: Coordinates X <br />CI PERC TES r (s) \ UMBER LAND USE APPLICATION # <br />TYPE OF WORK: 0 NEw INSTALLAlION REPAIR/ADINMEEN C?"EiNrEER DrI GN ED /ALTERNATIVE CC 0 REPLACEMENT DEsTRutrtoN L <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL Si FOUNDATION <br />DISPOSAL PONDS WIDT31 ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />SEEPAGE PITS Wioni ft LENGTH <br />DISTANCE TO NEAREST WELT <br />LEACH LINES 0 LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL <br />C3 FILTER BED Warm ft LENGTH <br />DISTANCE TO NEAREST WELL Si FOUNDATION <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />oF LINEN LENGTH OF LINES ft <br />ft FOUNDATION El PROPERTY LINE ft <br /> II DEM H ft <br /> <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br /> ft PROPERTY LINE ft <br />ft DEPTH ft <br /> ft PROPERTY LINE it <br />ft DEPTH ft <br /> <br />ft PROPERTY LINE ft <br />ft DEpTH ft <br />FOUNDATION It PROPERTY LINE ft <br />HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORN WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES <br />STATE LAWS AND RULES AND RF.G1ILATIONS OP SAN JOAQUIN COUNTY. <br />SIGNED <br /> H ANCE NOTICE REOLTRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />TITI.E DATE 6 <br />WAN r <br />r <br /> <br />1PIP' <br />0 <br />Ato- <br />_,C 1 '( <br />E.... <br />MEIER <br />PAY10. T <br />RECOVED <br />HEALI <br />05 <br />USE ONLY <br />Area c9-/ 2 Employee ION <br /> <br />SPECIAL PERMIT -Approved by <br />PIE/Sump Soil Character: <br />COMMENTS ..e.f ik.,c,-,,,....-t- e f f-cAc .-.....(4*.i.c... ccde ,.- it,04' - C±.3 c)41,44:4 . ro-t4...,..44.1re ..:. _ a , --/-.,Z..- eh i. -k-- /..t.,&.( "ELL: . ce. L'i.. C-Otre.....e..Gt ....7 C Pyle: ev-le- - ei..., <br />,....,..ie-- co ...-...— ..7-....eat 6,-e...- 14&- 6.-4.4) k,...) cow. e -e,-,/ .C. -A.---..e a*,--- • I "6.11 t4i•PAP-4 44,4 - <br />PE <br />Code <br />SC <br />inro <br />Received <br />B <br />.elge.k.#0."' <br />Cash <br />Amount <br />fiemitted pat'. <br />mit/ . <br />crvice Request St inYsiCt # Permit IOU <br />__Na.......- _ _....._ <br />le V • j pv.y, teraCAI/ <br />12/V02 ONSITE EWATER PERMIT <br />Application Accepted ply <br />Final I napeCtiOn By <br />Character of Soil to th of 3 Ft: <br />DEPARTMEN <br /> Date <br />Date