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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304EWUERAVE-3-17L-STOQRTON CA 95202-(209)4683020 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDREW s ;—(o": S ;^)g dxe.F9- Pa CTFYMP " er <br /> • <br /> CROSS STREET Lu. <br /> I pQ1P')',) e 0 APN �!D —uR— 3-] PARCEL SI]E e <br /> OWNERNAME T^UTA ✓�!1 CKXG eY PHONE <br /> OWNER ADDRESS snl'1^< CITV/SI'ATL74P <br /> CONST U71DR EC.Kty .(1/.Y PHONER-SL---229 <br /> CONTRACFORADDREM CDV/STATVZIP pyjOvzigzf <br /> LICMU ❑C42 0C-36 OTHER NUMBEREKPIRATIONDATE <br /> WATERTABLEDEPTH: R GEOGWPHIGLINPORMATION: Coordinates X V \)j <br /> ❑ PERC TEST N BUILDING PERMIT# LAND USE APPLICATION# g <br /> TYPE OF WORK: IV NEWITIRTALLATION ❑ REPMAJADDITION ❑ ENMNEENDESIGNED/ALTERNATIVE W <br /> O 51"La CEMEM ❑ DESrRUMON <br /> INSTALLATION WILL SERVE: 13RESIDENCE COMMERCIAL C�OTxaR <br /> /�NUMBEROP LIVING UNITS: NUMBEROFBEDROOMS: ++ NUMBER OF EMPLOYEES: <br /> ❑/SEPTIC TANK TYPE/MFG (0¢-I_ CAPACITY LarO Sial #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG /'� CAPACITY pi #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEAREST: WELL 951— R FOUNDATION Yi/.S I R PROPERTY LINE I q f ft <br /> ❑ LIFTSTATION SIZE TYPEOFFUMP ❑ SAND OIL SEPARATOR(ENCLOSED BYsrEM) <br /> RY LEACH LINES WCEACHING CHAMBERS 'y"/_�� #OF LINES E" LENGTH OF UNE t OD fl <br /> DrmANCETONEARESr WELL ;' OIOI R FOUNDATION /OI R PROPERTYLINE IT R <br /> ❑ FILTER BED WIDTx R LENGTH It DEPTH R <br /> DISTANCETONEARm WELLIt FOUNDATION It PROPERTY LME ft <br /> ❑ MOUNDED WIM ft LENGTH It DEPTH It <br /> DISTANCETONGREST WELL It FOUNDATION ft PROSPERITY LINE ft <br /> ❑ SUMPS W. ft LENGTH It DEPTH ft <br /> DISTANCETONEARE6T WELL 0 FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH—A LENGTH It DEPTH R <br /> DISTANCETONEAREST WELL It FOUNDATION It PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER Wmmx ft DEPTH d <br /> • DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LME R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACOORMNCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JMQUIN COUNTY. <br /> MI. MUM 20 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE.CALL(2M)953.7697 <br /> SIGNED L (i✓ TITLE /�/fYl"FfGG�fD✓- DATEILI <br /> �6 <br /> P <br /> i t L <br /> 1 <br /> E y, I <br /> n <br /> EPA RTMENT SU F,ONLY <br /> Application Auepled - Dam A. Employs lDk <br /> Final Inspection By Date U/S3/ems E3SPECIAL PERMIT-Appmved by <br /> Chander of SWl lSltep 91`317t; Pit/Samp Sall Ch traom <br /> COMMENTS N//.✓ (d:Z_ <br /> i <br /> PE SC RecelvM m9 <br /> AUDl Date Permitl InvDIreN Permit IDN <br /> Cade INFD B Caa6 Remitted SerWuR ."0 <br /> <3-03d01 ONSITE WASTEWATER PERMIT <br /> 12Yl2lLOW <br />