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web -01--06 05:09P P.02 <br />ONSITE WASTEWATER TREATMENT SYSTENrURMIT <br />SAN JnAQO1N CVUNTI' P.NvINUNMENTAI. HI:ALrN DEPARTMENT 306 E WEBER AVE - 3" FL • STOOKTON CA 95202 • (209) 161•3020 <br />ns ncA -I cOO crsv IN1NnFr-TInnis EXPIRES I YEAR fROM DATE ISSUED <br />fNVN-t(Erununn r. sr.ni.... - -- <br />CITV/ZIP Lasm <br />V• <br />rn <br />JVII ADDRESS A •rte--. <br />/ /11]fYien (�5 <br />CROSS STREET LJ�4jLQ—=, <br />�J �'Nn <br />APN I/Y��— PwRCEL SI7.E <br />e <br />/• <br />DESTRULDUN(L _ <br />vIwNE <br />G <br />DWNCA NAME, i/%IJ.�Tr <br />G <br />_O <br />y <br />ADORE-Stl.L, <br />m!h`1535 <br />ISTATE <br />1 CIPTY�i/IP, <br />SEPTIC TANK l'vr[IMFU <br />OWNER <br />� <br />PNONR <br />, O�� "'� <br />„� gal II OF COMYARTMENIj <br />CUnI"rTOR ._ '•A"• <br />- <br />CAPACITY <br />r &il 9 OF COMPARTMENTS <br />Cn'Yl$'I'ATE/%IF <br />C50 <br />CUN FRw CTOR ADDRESSILK _ <br />LAD 0 PROPEKTY LINE -�- fl <br />❑ <br />LICENCE C -a2 ❑ C-Jh OI HLk <br />_ _ NUMBRR EAPIKATION DATE <br />. <br />WATER TABLE DEP W___ it <br />CELIGNAYHICAL INFORMATION: Coordinates <br />❑ PERC TEST R 1iVILDING PERMIT ♦f ____ LAND USE APPLICATION # <br />__ __ <br />TYPE OFWORK: ❑ NY.W INSTALLATION it <br />RE.PAIRJADDTF VN <br />❑ LNCINEERDLYILNLDIALILKNAIP'L <br />Amounr <br />Remitted <br />❑ NEPLACENILNI' <br />Permit/- _-- <br />Service R ucsl b Invoice N <br />DESTRULDUN(L _ <br />INS"1"ALLATION WILL SERVE: R&SIIIP.N(:E <br />❑ CUMMER(AAI. <br />❑ OTKEN __•..,., __,�_ <br />1 <br />NUMIIHN OP LIVING UNITS: 1 NUMBER OP REDNOOMR: <br />NUMR(ROPEMPLOYEER: _ <br />7 <br />SEPTIC TANK l'vr[IMFU <br />fez- <br />CAYACII'Y <br />„� gal II OF COMYARTMENIj <br />❑ <br />GREASE'I'RAY TYYE/Mr"-r--- <br />O <br />CAPACITY <br />r &il 9 OF COMPARTMENTS <br />C50 <br />FOUNDATION_ <br />LAD 0 PROPEKTY LINE -�- fl <br />❑ <br />PKG TX PLANT DISI'ANCE'I.O NEAREST: Wrt.l._ <br />O <br />. <br />0 <br />I,IPTSTA,'ION SIZL _,, _,. TYPE OF PUMP <br />❑ SAND OIL SEPARATOR(ENCLOStV SYSTEM) <br />LEACII LINES I,( LEACHINC//F'IIAMBERSQ 36 <br />��R OF LINES LLNGI'H OF LINES AI 0 h <br />DISfwNC+E.7D�IP�AF.FT WELL ,,. <br />0 FOUNDATION_ Il PROPERTY LINE �_, _,_5,�,_.,.•R <br />❑ <br />)J <br />FILTER 29. �r •'�V M I1 'N(il- <br />-- <br />.... <br />—it DEPTII R <br />\ <br />TO N REST <br />R FOUNDATION <br />•_, Il PROPE0.TV LINE <br />❑ <br />MOUND inTH Le Nu H <br />1i DRPTII -_ _ 11 <br />UIRANCE TO 'ARES' L <br />it FOUNnATION <br />R PROPEATT LINE R <br />❑ <br />sumps Wlm'N _ __ LEN "t'l/ <br />1t DFPTR H <br />D1l1'whLt 1 <br />NE R5 WF.I.1. <br />it FOUNDATION <br />R P0.UPERTY LINE R <br />❑ <br />DISPOSAL PONDS WIn,N_ <br />_ __-R LENGIN <br />111 DFPTR R <br />DISTANCE IUNLAKE51WIiLL <br />H FOIINDATION <br />_ (l PROPERTY LINE 11 <br />SEEPACE PITS NUMKF.K _,_1_WtOTII <br />H DEPTH _J it <br />DISTANCE TO NEANESI' WELL __jQCj+ R FOUNDATION_ <br />�L <br />ft PROPERTY LINE It <br />I IIY.HCBY C'f.KI IFY 'THAT 1 HAVE PRF,PAREII TIIIS APPI.ICATION AND <br />IME WORK WILL UE DUNE IN ACLONUAN'CE WFfil SAN JOAQUIN COUNTY <br />ORD/II''NN�A\CFS, STATE LAWS AND RULES ANO KECULA1'IUNS OF SAN JOAQUIN COUNTY. <br />MINI <br />Se IID t <br />tt,,11'II Elk\U'1){\CE Nl:QUINEU <br />FON Iy,yPl (-1' <br />-1'L!'4 'fA (209) 953-7647 <br />��/J� <br />V <br />llll/l/VlX-CJL� <br />„TLE}L <br />i 0 <br />SIUNL <br />/Ax <br />l <br />DA,1;I <br />APPIKAtion Accepted By <br />Find Imitation By <br />CLKrarler of Sol] to De(n <br />COMMENTS r)L <br />/j/� DEPARTMENT US .O LV f <br />Date /1 l G'S Area Employee lUn ctGyS cc <br />Date _� O ❑ SPECIAL PERMIT-APProvcd by 7 <br />of 3 >•�___ D uSRlnp Soil Charmer. <br />SOC:: <br />! L <br />PE <br />Code <br />Sc Received <br />INFO <br />CKIh <br />Amounr <br />Remitted <br />Date <br />Permit/- _-- <br />Service R ucsl b Invoice N <br />- <br />-42.19 <br />Ifs 1 <br />7 <br />fez- <br />