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ONSITE WASTEWATER TREATMENT SYSTEM PE.RM11 s <br />SAN JOAQLIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 6611 EA'IAIN STREET -STOC,: <br />`ON -REFUNDABLE PERtIITCALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DA— T.-rcn <br />JODADDRE&S .1s 7�7 ,/V_ C-'41SO��t/�`r CITU/IJP <br />CROSSSTREET L«T%Z-Ei{ f�/�I J APN D:53 - C'O — D i./ PARCEL SIZE <br />OWNERN.iMe T PHONE <br />OWNER ADD.ZESS I _ CITi'/STATElZIP <br />CONTRACTOR PHONE <br />CONTRACTOR ADDRESS <br />CITY/STATEIZIP <br />LICENSE JW C42 Cl C-36 OTHER NUMaeR� Ea(PIRAT[ON DATE <br />WATER TABLE DEPTH:-- <br />f2 GEOGRAPHICAL INFORMATION: CoordiDeteS X <br />O FERC TEST #Y <br />BUILDING PERMIT # <br />LAND USE APPLICATION 7 <br />TYPE OF WORK: <br />❑ NEW INSTALLATION ❑ <br />REPAIR/ADDITION <br />❑ <br />❑ REPLACEMENT <br />ENGIhTZR DIV <br />ESIGNED/ALTERNATE <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />X41 <br />O COMMERCIAL <br />DESTRUC110N <br />❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS• <br />NllMBe.R OF EA/PLOYEES <br />Ll SEPPICTANK <br />TYPFIMFG_ <br />® CREASE TRAP <br />TYPER.UFc <br />CAPACITY <br />gal # OF COMPARTMENTS <br />■ <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />TI FOUNDATION <br />R <br />❑ LIFTSTATION <br />SIZE TYPE OF PUMP <br />PROPERTY LINE ft <br />❑ <br />— <br />PNG <br />TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />05•]012007 ONSITE WASTEWATER PERWIT <br />l <br />I <br />■ . 1 1 <br />■ <br />I <br />■ <br />1 . <br />■E■■■ <br />I. <br />■■■■■■■ONE ■■■■■ <br />MEMO ONES ■■■■■■■■ MIENS <br />■■NN■■■■M■EE■MM■■ MEMNNOME <br />ME■N ■■IM■■■■EE■_��NE■■■MEIN <br />■MEE�NE■■■NP��i <br />■■■■■■■■■_�•��■■■■ <br />■■���'�rM■■■■■■■ <br />■■_ i�•Ir�■■■NMI■■■■■■ <br />NOME <br />WE 'INN 1■■■NE■ ■N <br />■■■■■■■■MMIEM <br />■M■■M�:�■■■ ■■EENT■NM■MVM <br />100L'L'lJMN■■■ii[7■■ <br />■NE■■■■NN■■■■■■■■■/ <br />ENMI■E■■■iii■■ <br />■■■NPrAm■I!_Illlt�!■N■■trli <br />ME <br />■■■■■■■■■■■■ <br />■■ <br />so EREM <br />■M■�JE�.43w■\\■■■EE <br />■M■■■M■MMM■ n■6\\Vi!lIMNMiA■■■■■■■ <br />■■NI N■M■■ NM■■M\N►\■■1.d■■PAPAMOM <br />■■■NiN\■■ ■■NE■N■■■■iM■ <br />lit ■MMI■■1■E <br />■ MM_■M■E <br />NNMM■NMN ■NNN■r.MM <br />NONE <br />■■■■■NMrr ■■M■NIM■■■■N■■NM■■■IE■EMI■ <br />t■M■M■■■ _'SEE ■■■■■M■N■MEN <br />■MNM■EM M■um_■E■NEMEEE■■ <br />NOME MEM■■�►�1■MM■■■■■MIN■MEMM■■■■■M <br />Now ■■■■N■■■■ ■■�■SME <br />■ ■N■NN <br />■MNN■MEMO ■■MEMO <br />NEE■■■■MEEE ■NONE <br />■■ ■ <br />rail. 1 <br />05•]012007 ONSITE WASTEWATER PERWIT <br />l <br />