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'I V:j -r <br /> ONSITE WASTEWATER TREATME\T SYSTEM PERMIT <br /> ,AN JOAQL9N'COUNTS'EN'VIRONMEN'TAL HEALTH DEPARTd1E.NT 304 E 1YEBER Ar'E-3"'FL-STOCKTON CA 95202 - (209)46A-3420 <br /> NON-REFUNDABLE PERMIT C LL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> OB ADDRESS /.? -✓• Imo. CITYIzIP <br /> APN )T:(" -1 y Ci-�f PARCELSIZE <br /> F�!ROSS STREET <br /> OW'N'ER NA,IIE JHONE <br /> IWNER ADDR Ess �� ✓ CITYlSI'ATEfZIP 6; - <br /> `�t`I PHONE <br /> '37e1 <br /> !!! .ONTRACf0R r1jf/ ( 1 <br /> CONTRACTOR ADDRESS " � 4� 0TYIS3'ATEMP `�.�r` i( { <br /> (CENSE 0 C-42 ❑C-36 OTHER NUNIHER EXPIRATION DATE � <br /> V TER TABLE DEPTH: fl CEOCRAPHICALINFORHATION: Coordinates X _ y - <br /> PE RC TEST(S) 1 LAND USE APPLICATION F <br /> YPEOFNVORK: ❑ NEWINSTALLATION ❑ RLPAIR)ADDITIO,I' ❑ ENGINEERDESIGNEU/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> NSTALLATID:N'NV'ILL SERVE: ❑ RESIDENCE -`I L�. CONLr1ERC1AL OTHER _ <br /> NUMBER OF LIVING UNITS: NUMBER OF SEDROONIS: \UNSER OF EMPLOYEES: <br /> 1f�C-l'1 SEPTICTANK TYPE;MeO CAPACITY 9Al .4 OF COMPARTMENTS <br /> J CREASE TRIP TYPEIMFO CAPACITY gal II OF COMPARTMENTS !1` <br /> i <br /> * PKG TX PLANT DISTANCE,TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE -fl <br /> ❑ LIFT STATION SIZE TYPE OP PU%IP ❑ SAND OIL SEPARATOR(ENCLOSE)SYSTEM) <br /> �7 LEACH L1NE5 ❑ LEACIJtNG CHA 11 BE p oP L{NEs LENGTH OF LINES R <br /> D(STANCE TO NC ARI, WELL fl FOUNDATION ft PROPERTY UNE ft <br /> U FILTER RED WID-fil fl LENGTH ft - DEPTH tt <br /> FDISTANCETO NEAREST WELL raft;"XCUNDATION fl PROPERTY LINE f1 <br /> MOUNDED WIDTH tt LENGTH 1 Il DEPTH fl <br /> DISTANCE TO NEAREST WELLL•` fl FOUNDATION ft PROPERTY LINE R <br /> _4 R <br /> Q SUMPS .WIDTH ft LENGTH R DEPTH <br /> _ DDISTANCETO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> O DISPOSAL PONDS -WIDTH fl LENGTH R DEPTH ti <br /> F0 <br /> t <br /> `DISTANCETO NEAREST &'ELL R FOUNDATION ti PROPERTY LINE R <br /> U SEEPAGE PITS WIDTH R LENOTH il DEPTH tl <br /> 'DISTANCE TO NEARSPT WELL R FOUNDATION + fl PROPERTYLINE TI <br /> I HEREBY CERTEPY THAT l HAVE PREPARED THIS APPLICATION AND THE WORK WILT.BE DONE IN ACCORDANCE WITH SAN JOAQU[N CDL NTYORDINA,YCES, <br /> F. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUM1 TY. <br /> 1 V 1'I\UH 24 HOUR ADVANCE NOTICE REQUIRED FOR Itis/PgC�T,I, NS- LF.HtSE CALL(?09)953-1697 / <br /> �� DATE <br /> F-SIGNED) . ..F __ TITLE <br /> w,01b N atC= <br /> x aaeomr� . <br /> e 4 �1 <br /> l C!3 dsx'csl'�nlo+reveo nxals - ! <br /> z _ - W.elaw.wcn �.— <br /> t3 <br /> W !.e1Lt <br /> �I r ) h L__�.._-_ N Y <br /> 03 _:._.r_ <br /> RE <br /> S Y GG <br /> as r�. .e j Nma i�zS7L g�y��SA J• i Ind° <br /> 01 i o n ,teem Sf� NVI <br /> �-I <br /> r L G <br /> DEPA�`k.Tpl£AT s' hL '+' '`_ wy <br /> plfc'dnorvlA{cepied`By <br /> ' ik,a'I Itlapexi'ilon By - Date - ❑ SPECIAL PERN11T,-Approved by - <br /> �- harlicter df Soil toDepth?of3 Ft: PiUSu1 i mp Soil Character: <br /> �Olv[NsENTS <br /> F CPE•.,, SC Received 1 Amount = at Permitl� Invoice A Permit I <br /> ode INFO B sh 'tted Service Request 0 <br /> 1 <br /> 42-DI-001 ONSITE WASTEWATER ERIAT '1 <br /> l2'2i02 - <br />