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I PllJam/-,-w <br /> ONSITE WAST`-WATER TREATMENT SYSTEM FERMI"' <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH I`_�TMENT JW E WESERAVE-3'"FL-STOC °95202-(2O9)dAB'N38 <br /> NON-REFUNDABLE PERMIT IIP.•A LL(2091 953-7 69 7 FOR INSPECTIONS EXPIRES 14FSAR FROM DATE IaEDED <br /> N <br /> JOB ADYRESF Jl D 1741 T70 PARCEL SZO <br /> LCRRT ^ <br /> D <br /> IRR OWNER NAME PHONE <br /> OWNER ADDRESS CITY/STATBIZIP /� <br /> CONTRACTOR N !J V/ -J-/'V L PHONE Z-.r— <br /> `F CONTMGTOR AODRPSE �C , /�� ZJ/IL.CRYISfJ'TPI-P� p� <br /> LICENSE 2 OCJiYT <br /> 6 OTHER NUMBE0. 2EXPIGTION DATE V Lo soeI \ <br /> WATER TABLE DEPTH: ft GEOORAPHICALINFORMATION: COOrdinaw % Y W <br /> ❑ PERC TEST(S) NUMBER LANOUSEAPPLICATIONN <br /> TYPEOFWORK: J9.. NEWINSTALLATION ❑ REPAIWADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE PA <br /> ❑ REPLACEMENT ❑ DESIAuCTION VF <br /> L NSTALLAT ON WILL SERVE: ESIDKncE ❑ COMMERCI L ❑ OTHER <br /> �[ NVMBEROFLIVINGUNRS: NVMBLROP BEDROOMS: Az// /] NVMBEROPIUA EES: <br /> 9F SEPTICTANK TYPEMEG PACRY__f [L BSI NOF COMPARTMENis L <br /> ❑ GREASE TRAP TYPFJMPO CAPACITY BBI N OF COMPARTMENTS <br /> L ❑ PEG TX PLANT DISTANCETo NEARLST WELL iia ft FWnDATION� ft PROPERTY LINE fl v <br /> ❑ LIFT STATION SIEE TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Oe—LEACH LINES ❑ LEACHING CHAMBERS N OF LINES ,eF2 LENGTH OF LINES O ft <br /> DMT / J <br /> ANCETONEAREST WELL <br /> 3D R FOUNDATION .D R PROPERTY UNE ZSR It <br /> ` ❑ FILTERBED WIDTH R LENGTH R DEPT fl <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH fl <br /> DISTANCKTONEARPST WELL R FWNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS DO. ft LENGTH R DEPTH ft <br /> DISTANCETONEARETT WELL R FWNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL FONDS Wwrx ft LENGTH R DEPTH R <br /> DISTANCLToNNEAREST WELL R FOUNDATION-ft PROPERTYYft <br /> ! TLME <br /> Jq SEEPAGE PITS WIDTH 3rR LL �' R DEPTH V ft <br /> ` WRTANCETONEAREST WELLinn R FOUNDATION 4fjo—ft PROPERTY LINE Z..5_ ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCE& <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M MUMH URA VANCE ICE"24U] FOR INSP£2TJFIONS-PLEASE CALL(209)933-7 <br /> SIGNED 6'- TITLE V JO'!^1/ DATE 0 <br /> J I <br /> ,15 <br /> If <br /> VI O M NT <br /> L <br /> i <br /> „J :I <br /> L <br /> DEPARTMENT US ONLY C <br /> ApplKIttion Accepted B DRIP � 1 U AB. I( E ppmvec IDN S9`E4 9/ <br /> FlnIIII.I xtinn ey =;;7 Dnle�— ❑ SPECIAL PERMIT-APPmved by <br /> CSarRHer a Soe to De R 9T3 Ft PIU$ p Soll CMmchr: <br /> ` COMMENTS AT t91 ll�.[ tt ds i"A—103-'(93 <br /> PE BC Reetived a Amox0.t ate Permitl Invol.# Permit IM <br /> Cede IxFo B nb Remitted Servke Remk <br /> 0#2.11 -- 03`124 <br /> R-0I-0DI ONSITE WASTEWATER PERMIT <br /> ` I DDJ <br /> 6. <br />