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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> $ANJOAQUIN COIINfY ENVIRONMENTAL HEALTH DEPARPMENT 304E WEBERAVE-3Y FL-STOCKTON CA 95102•(209)4E¢1 <br /> NON=JMAMRM <br /> REFUNDABLE PERMIT CALL 2091953-7697 FOR INSPECTIONS EXPIRES n`EAR FROM DATE ISSUED <br /> $ Z G ! fA ill EJB CITV/21P4YT rl 1^� APN ZZ4 (it? 74, PARCEL SIZE1 T N^n'pu •�-C���, I,�N��J� <br /> CONTRARORADDRESS CRY/NTATE21P <br /> NUMBER ]EXPIRATION DATE <br /> LICENSE ❑c42 ❑c-Js OTHER Y <br /> i WATERTABLEDEPTH: D GE%RAPHIGLINFORIHATION: C"Nfi iaT X <br /> ❑ PERCTEST k BUILDING PERMIT# LAND DSE APPLIGTION# <br /> ❑ ENGINEER DE6IGN /ALTEWFATIVE <br /> 1 TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIP/ADORNIN <br /> REPIACEMENi' DESTRUCTION <br /> )� <br /> IL 043 r <br /> ❑ RER <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL NUMSEROFEMPLOYEES: <br /> NUMBEROP LIVING UNRS: (J NUMBER OF BEDROOMS: <br /> �Y�SEPTIC TANK TYPEJMFG r'1 CAM EY �C CAPACITY !9 0 0 Fall kOFCOMPARTMENTS 7/ <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY pl kOFCOMPARTMENTS <br /> ft FOUNDATION ft PROPERTY LINE 'S 0 (� <br /> ❑ PKC TX PLANT DISTANCEM NLAn£AT: WELL _ —j- -- <br /> ❑ LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENL104ED SYSTFAI) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS kOP LINES LENGTH OF LINES <br /> ft <br /> 1 DIS[ANCL TO NEARC41' WELL ft F9UNDATION ft PROPERTY LME ftfl <br /> i -4 FILTER BED WIDTH 2D ft LENGTH 7K ft DEPT'N <br /> DISTANCETONEAREST WElNt RFOUNDATION D ft PROPERTY LME S R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> Mi PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL fl fl <br /> V <br /> EI sumps WIDTH ft LENGTH It DEPTH <br /> It FOUNDATION ft PROPERTYUNE ft <br /> DISTANCE TONEARFST WELL ft <br /> ❑ DISPOSAL PONDS Will ft LENGTH It DEPTH <br /> ft PROPERTY Lin£ ft <br /> DLSTANCETVI NEARFSt WELL <br /> It FOUNDATIONR <br /> ❑ SEEPAGE PITS NOMeec WiMN ft DEPTH <br /> DISTANCE TO NEA0.FST WELL ft FOUNDATMIN <br /> ft PROPE0.tt LM¢ ft <br /> IHEREBY CERTIFY THAT I HAVE PRNPAREDTHiS LAWBCATION AND AND <br /> ANDREGUK ION SO DONE IN <br /> ACCORDANCE <br /> QUIN 'VITR SAN JOAQUIN COUNTY t <br /> ORD <br /> MI IMU Q!!t(EIIVA'Cl(RICE REQUIRED FOR INSPF. �,'S-PLEAE.UL 209)95]-]69T <br /> YTsC`I <br /> SIGNED TITLE DATE l /V <br /> I ` <br /> ID <br /> 1 U J <br /> Ct JL <br /> Y ! <br /> O IN <br /> DEPARTMENT USEONLY <br /> AN <br /> ;II <br /> Auepled Date -Approved by <br /> +ce, Employee lDk p <br /> Fincts edlso <br /> — <br /> � IJ SPECIAL PERMIT <br /> FIRM S <br /> Chander of Soll to tM1 of J FD PiUSnmp Soii CM1aradR: <br /> COMMENTS <br /> PE SC RecelveB Chet Am9oat Dau PerMt/ IRvokek Permit Im <br /> Code IN B Ill Cash RemfthNl ServkeR k <br /> D 2 S2Q0 i ! <br /> 431 ONSITE WASTEWATER PERMIT <br /> LJLJNJ <br />