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7,'rh 1,; 7- r.1 17--4-1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH D[-:PARTIVIENT i'.A"L.L!UN,`1VL-i WE-STOCKTON CA 96205-(709)463-34 n- NON.-REFUNDABLE PERMIT `3" f..lt21r FOR fiNISPECTIONS EXPIRES 1, YEAR FIROVsh CIATE ISSUED Jon ADDRESS ',-,ITY/. IP CRoss S-rREET A-PN 77 rIn—C#F(A PARCEL SIZE OWNER N +c AM PHONE y" CINnIEI ADDRE-FIS C o R A C.10 P PHONE CONTRACTOR ADDRESS 921572 LicH.NSE OFIC-42 I-IFIC..36 0711ER I\IumrER (V_Oss�____ExPIRATION DATE MATER TABLE DEPTH: fl. GnEOGR-APHICAL INFORMATION: (';c)Or d I i i a It.0 s 1-1 FERC TEST # NG PERIVIIT x 1 LAND USE ft APPLICATION P 117 wor STALLATION 1*1 REPAIRIADDITION 1.1 ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF.SERVICESEPTIC SYSTEM I DESTRUCTION IN S3TA L.LATION VVILL SERVE: COMMERCIAL D OTHER NumnEp or LIVING UNITS: Nluin'Eii OF�_lEumoolvis: -.R OF EMPLOYEES: 5"Fzr, TIC,TANK GAIIAGITY �.)M 4 OF COMPARTMENTS-_y. GR.EASE TRAP TYPE/N1h:c; CA11A(,J1Y gal #orCOMPARTMENTS_ DISTANCE To TAIL"-AI EsT: WELI. ft FOUNDATION ft PROPERTY LINE ft LIFT STATION SIZE TYPE OF PLIWIP 0 PKG TX PLANT 1-7. 'S, UNID OIL Z,71.::.I:IAPA'I'OP(EMCLO'_--�ED S'Y:3TEi)A) r..sr &01 LEACH LINES 11 LEACHINGGIIAMBERS—_ ft OF LINES LIENGTH OF LINES fl: DISTANCE TO NEAREST ft FOUNDATION ft PROPERTY LINE ft FILTER,LIED Vviuni ft LENGTH DEPTH ft DISTANCE TO NEAREST WELL ft mutiDATION ft PROPERTY LINE ft MOUNDED xflflr),I,I-1 fl. LENGTH ft DEP,rFi ft DISTANCE TO NEAREST WE-LL fi f-(-)[)Nr.)A'F](.)N ft. PROPERTY LINE ft V.<wffP& � e4 WIDTH ft LENGTH ft DEPT-i-i 161 ft jp.♦1- eftcl_ L-L -Gf-, DISTANCE To NEAREST WEL 1. 7 0 111 FOUNDATION ft PROPERTY LINE J 61 ft Ca DISPOSAL PONDS I'ViDim ft Luic,I ii-i rI DEPTH ft DISTANCE TO NEAREST WELL ft FOUNr)ATION —ft PROPERTY LINE ft SEEPAGE PITS NUMBER_ WIDTH --ft DEPTH ft DISTANCE TO NEAREST HELL ft FOUNDATION ft PROPERTY LINE ft I HERE13,111 CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL 13E DONE IN ACCORDANCE VVITr-I SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 11111V1 IV 1,- 3 UR ADVAINCE OTICE RE 1.11RED FOR UVSFIECMN�� --f SIGNED DATE ----------- Ty 4 R T hrl FIN T US E 0 IV L Y 7^ q Application Accepted By Area Employee I D11 Filial Imz;ppcU0n D'a t e [I FPECIAI_,'F'EPMIT-Approved by Charartcr of Soil to Depth of 3 Ft: Pit/- '11PS i I Char'acter': NITS -y-pe. t7 CC IME e . 0v% iv-di�ecoPei wolce 41. Date Permit 04, By ca s 11 Rpinitted Sc rwlce juest P) ................................ olqsl,rF WASTEWATER TRTMNT SYSTEM PERMIT