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SAN JOAQUIN COUNTY'.--NV1f-,0NMENTAL FIEALTH DEPARTMENT 1868 E.HAZEL-rom AVENUE-STOC K TON CR,05205-(209)468-3420 <br /> McIN-REFUND/M3f :dT C,4 L L(2 9 <br /> a N Exr,11RES I YEEAR FRom DATE ISSUEED <br /> FOR WsPixv S <br /> Jon Ar)orif--ss j <br /> CROSS APN PARCEL-SIZE. <br /> PHONE <br /> CANNER ADDRESS, CITY/STATE/CAP <br /> CONTRACTORPHONE It <br /> Com-rRACTOR ADDRESS I(e S-a <br /> ---ITY1STATr-[2AP <br /> ICF.NSE 111-K-42 011C...3e, OTi-ir-R__ NUMBER EXPIRATION IDATE <br /> VVATER TABLE DEPTH: It GEOGRAPHICAL..INFORMATION: Coordinates y <br /> P V:R C i,r--C.T �-E-Rm F, --L 3--T--AND USE APPLICATION 11 <br /> f'! REPAIR/ADDITION'---------"-'--Tl- ENGINEERDESIGIIEDIAI-TERNATiVr-- <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION <br /> INSTALLATION WILL SERVE: �ES I D E-N C E 0 COMMERCIAL ID 01-HEP <br /> NumnER or LIVING UNITS- NUMBER OF BEDROOMS: NUMCER OF EMPLOYEES:____ <br /> 9�-S-'rEErTICTANK 'TYpF/MF:G GAPACITYap —. g a I #OF COMPARTMENTS <br /> CDRIE'ASETRAP TYpE/11/1F(., CAPACITY9,11 #OF COMPARTMENTS <br /> T: Wo-i. 1 <br /> DISTANCE To NEARES ft FoumnA-ri(.)N ft PRo[-IERTY LINE <br /> Q LIFT STATION SIZE TYPE OF 0 PKG TX PLANT (-3, SAND OIL SEPARAICIR(ENCLOSED SYSTEM) <br /> 'i-c-ACH,LINES U LEACHING CHAMBERS -k or LINES LENGTHOFLINES <br /> DISTANCE To NEAREST PROPERTY LINE__ ft <br /> FILTET,03F ID 'Allo,f 1-1 --.-- ft LENGTH ft DEPTH ft <br /> DISTANCE'To NEAREST fi ['01-Ii,im riniq —ft PROPERTY LINE- fl. <br /> Wi(JUNDED VVIDTH It I-EI\IGTFI.-..- ft DEPTH ft <br /> DiSTANCi To NEAREST V\jEt_j_ ft FOUNDATION fl' PROPERTY UNE ft <br /> W--*'S'umps fl. Lr=NC;THft. DEPTH It <br /> L4 <br /> DISTANCE To NEAREST WF-Ll-....l X01 ft FOUNDATION ft PROPERTY LINE -in' ft <br /> 173 DISPOSAL PONDS !,,Ihr)T.tjft LLNc;'rj I —fl DEPTH 1`1 <br /> DISTANCE To NEAREST WELL I[ FOUNDATION ft rROPERTY LINEJ :SEEPAGE PITS ft <br /> Numm VVIDTH ft, Dun+i ft <br /> DISTANCE TO NEAREST ft FOUNnATION ft PROPERTY I-INE_._ ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE 11111TH SANJOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND PULES AND REGULATIONS OF:SAN JOAQUIN COUNTY. <br /> !jjLfffv1QA"1A,PiCJwf- 'QFA <br /> 1SPE-CTIONS PLEASE CA 953-7697 <br /> U-12 <br /> SIGNET.') TITLE Cbn-�rccd..r <br /> DATE <br /> ............. <br /> EPA RTfl 13 ONLY L.E Y <br /> Application Accepted By De,Le f Area aAA Employee lD *11-.L4u--/' <br /> Pinat inspection By Date D SPECIAL PERMIT-AT.Iprovecl by <br /> ,hal*,acter of Soil to Depth of 3 Pit/Sku-np Soil Chavarter: <br /> COMMENTS <br /> Date invoice invoice# Permit JD# <br /> Corin. ImFo By n-,s) rennitted Re:lujgst it <br /> ----------- <br /> -c� <br /> ONSITE WASTEWATER TRTRANT SY!3TEM PERMIT <br />