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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> .�W JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET- <br /> ON CA •(2091468,3420 <br /> NON-REFUNDABLE PERMIT CALL 209)953.7697 FOR INSPECTONS EXPIRES 1 YEAR FROM DATE ISSuED <br /> Job ADDRESS, 7 S MR D. cmrzlP f.r}'n-FI?OP L.4 95,930 w <br /> CRIBS STREET _ r10 APN iSI -2392-197-' <br /> _ <br /> PARCEL SRE _�,7y� <br /> OWNER NAME PiLUE�IIZL+T NJ ( PHONE <br /> OWNER ADDRESS IZOL I S A4&h(11-FF>f L1 CITY(STATEZP <br /> CONTRACTOR P17F5TiD'� RLP E t l�S PHONE <br /> CONTRACTOR ADDRESS .1Z6�� '1 /V'ff fTHtF bD COWSTATIUMP�'I'k•z01� 4A- rL <br /> LICENSE ❑C47 FIC-30 OTHER_ Q —� <br /> NUMBER '3iP7"O EWIRATION DATE <br /> 4 <br /> WATER TABLE DEPRI: f k GE06RApXNTAL INFORMATION: COOTOIDBTCe X <br /> Y <br /> ❑ PERCT # BUILDING PERMIT II LAND U--;— <br /> TIESN <br /> E F WORK: NEW HSTALLATIO <br /> _ RFPUR/AD01T1U ENGINEYR DESIONEO fAITERNATIVF $$$¢¢¢ <br /> I REPLACEMENT - DESTRUCTION <br /> INSTALLATION WILL SERVE: CE COMM¢RC L O OTHER ; <br /> NUMBEROFLNWOUNITB;_ NUMBER OF BEDROOMS: / <br /> NUMBER OF EMPLOYEES: <br /> �. SEPTIC TANK TYPEIMFD r <br /> ❑ GREASETRAP TVP C AGTY C U- Gal #CFCOMPARTMENTS Z Nff <br /> \COY gal #OFCOMPARTMENTS <br /> OISTANCETONEAREST: WELL k FOUNOATICW it PROPERTY LINE k - <br /> ❑ LIFTSTA710N SIZE TYPE OF PUMP ❑ PKGT%PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I _ � <br /> ❑ LEACHLINES _ LEACHING AMBERS 4FM <br /> LINEB LENGTHOF P <br /> DIBTANC TO NEAR T WELL it P ERTYIIN flFILTER BED WOTN R yLE�NGTHry DEPTH — fr RDISTANCE TON T WELL'I'y7 _��it P TY <br /> ❑ MOUNDED WIDM R LENGTHR DEPTH <br /> DISTANSETONEAREST WELL__fl FWNOATION <br /> R <br /> R PROPEFtTY LINE R <br /> 13 BUMP$ WIM n LENGTH_ R DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNOAT.Q4 It ft PROPERTY LINE It❑ DISPOSAL PONDS WIDTH k LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL tt <br /> R FOUNDATION k PROPERTY LINE it <br /> ❑ SEEPAGEPITS NuMBEa WE, ft DEPTH p <br /> DEITANCETONEAREST WELL R FOUNDATION <br /> It PROPERTY LINE it <br /> 1 HEREBY CERTIFY TNATI HAVE PREPARED THIS APPLICATION ANO THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN 000HW- <br /> ////�j/RUNIMU�MSA/p R ADVANCE NOTICEREOUIRED FOR INSPECTIONS•PLEASE CALL(209)963-7697 <br /> SIGNE�k'--�/' `�CG-W.5 iRLE_ pop <br /> GATE <br /> �• 3 <br /> TI­ <br /> p Ij2 . : o DISPLAY STU <br /> (N0.Bull <br /> Au' 'A5 R�:tS�'I "� C00 U <br /> v � F�bT" i <br /> ,,'l ; • .L("n - _ RcO. .L3- -L3 I _y 35 . � <br /> _J • v <br /> ARTMENT UB ON <br /> ApplllatlOn Awptatl TIL-- Area Empbyee 7D# ^[9 <br /> FITIS)Impaction Pto C SPECIAL PERMIT / <br /> ChenUaro/SOU to plh INS U e!e �2 Approved by <br /> PiU9um aRl <br /> COMMENTS ChareClan <br /> D S <br /> o Z 3S <br /> P SC Recelvetl ChB Amount <br /> CILTa INFO B an Remitted Date Service Re t# Invoice Permit ION <br /> g <br /> f <br />