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7►" ONSITE WASTEWATER TgEATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304EWOMAVE-3-FL-STO('KTONCA95202 -(209)4684420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> • JOBADDRESS IUliq tAiL 14l- — Cfrv/21P 4j-jA.•L4- N �142-f <br /> CROSSSTREET APIN D FnR_CF.LSVS�./ijC -r e <br /> OWNERNAME 1�1eC4w V� r.9�\� PHONE (&24 <br /> OWNER ADDRESS CITYISTATFlJJP YEN G YA vT {3Y <br /> CONTRACTOR 1- <br /> CUNTRARORADDRESS CITY/STATFJEIP <br /> LI(fNPR. 0C.42 LI C-36 OTHER NUMRRR E%PIRA'FIUNDATE <br /> WATERTARLEDEPTH: Ile A GEOGRAPHICALINFORMATION: Coordinate, X Y <br /> ❑ PIA[ TEST # _- RCILDING PERMIT# LAND USE APPLICATION'#�� <br /> TYPEOF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEEROESIGNEn/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL (3 OTHER <br /> NUMBER OF <br /> LIYISO UNIT: - / NCMRF.R OF BEDROOMS:_ Z NGMBEP OF EMPLOYEES: <br /> SEPTICTANK TYPEIMFG '?+I-4J4 CQ•N4,iti'2 CAPACITY 1200 $:1 MOFCOMPARTMEI'IS _ <br /> ❑ GREASETRAP TYPEIMFO__, _ CAPACITY PI #Ot COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEARMST: Wrtl ft FOUNDATION R PXOPERSYLINF _ R <br /> ❑ LIFT STATION Slzs TY'PEOPPUMP ❑ SAND OIL SEPARATOR(ENCI.OSCDSYSTEM) <br /> IF LEACH LINES ❑ LEACHING CHAMBERS Op #OF LDIEs�I LEN M, 1 OF LINES 80 _ft <br /> DISTANCETUNEARFST WFLL (-/ -_A rOUNnnrm Lf!�- _ft PROPERTY[INr. ._ft <br /> ❑ FILTER BED WIDTH ft Lewril ft DEMI ft <br /> DISTANCE FO NEAREST W.N. ft FOUNDATION_ R PROPERTY LIHE ft <br /> ❑ MOUNDED N'mix ft LENGTH_ R DEPTH__ R <br /> DISTANOETONEARUT W.I.) ft F<N:NDATI(1\ Il PROPERTYWT R <br /> ❑ SUMPS WIDTH A LENGTI1 Il IXPTH _ R <br /> DIi1'ASGP.TONEAREST WELL ft FOCNDANON ,__ft PROPERTYUNE <br /> ❑ DISPOSALPONDS WIDIN _A LENn'H_ __. „_R DEPTH ft <br /> DISTANCPTONEAREST WELL YI MUWA'IION__, Fl PROPERTY�E A <br /> • <br /> CI SEEPAGE PITS Nu.". J� WIDTH� -__fi DEPtH zS R <br /> WI <br /> DISTANCE TO NEAREST LL I1yp_ft FOU1OXTION 60 Il PROPERTY LINE 1.1 R <br /> I HEREBY CERTIFY THAI1 HAVE PREPARED THISAPPI.K:A'FROM AND THE WORK WILL BE DONE 1.1 ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGLLATIONSOF SAN JOAQUIN CDUNTY. <br /> IM/L'//{12 MfHADYANCE NOT[('E REQUIRED FOR INSPECTIONS-PLF.ASP.CALLC091953-7691 <br /> SIGNED TITLE SirY- Ih DATE �f'•w( �II 2U[)�' <br /> 1 <br /> 4 <br /> / <br /> n:l <br /> H M TL <br /> T� <br /> r b <br /> E_P RTVIF.NT U._ Y <br /> Appticalbn AttePl ahArea EmPbym III# I <br /> Final Iftowtion t ., - CC _ Dole//-r �___ ❑ SPECIAL PERMIT-APPlovodbY <br /> Ch.mutrorzilto 113 Ft PfUSDmp Soil rharoemr. <br /> • COMMENTS /7.D 1A[S( nG ,AF�7- y4 f<- "�, —.n .MIL 64 13f141 ey. 1 <br /> f::rn..�_s.�'rh'<.:cinv:J� F, we % t <br /> 1 r <br /> _,Ile V,Z <br /> PE SC Recdretl CAm Aownm - Permit �_ Inmke# Pernt6lDp <br /> PE HSC lean <br /> 14;p_ ad Date lSFnfce Re uen# <br /> D l Y tl 0 Sri` I <br /> a.nx.00l<„'jP/ k••G T/Ul!G/tem. <r_ �.,�I(., ;'i,.'.,l .<i..'..yiCc.f_9� L'e i:]i'itc. ONEITEWASTEATER PERMIT <br /> Hzs.•zaD:l ' <br />