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ONSITE WASTEWATER TREATMENT SYSTEM PER S•''` ' ' <br /> SAN JOAQUIN COUNTY ENVIRONMBNFALHEALix DBPARTMENF 3IMEWEBERAn.r FL-RFOCKTONCA95202- 12091,168-3020 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADORERSC/I.F/v2n• �•F��, Cl.I..L �If. m <br /> CROESnRER a <br /> / w< APN L`3 �21,1. —L- PARcRL sin ei 1 e <br /> OWNER NAME t 1/1 �> L��1 I r i(!{f 14 PHONE / �G <br /> OWNER ADDRESS ;e' lclqq CIIYJSI'ATETIJP�j (•v/ l/—,, >q�S; <br /> CONTRACTOR T ALI CIA. PHONE <br /> CONTMCIOR ADDRLSS '� �.I CRYMATUZIP <br /> LN2NBE C1 C-12 C!C-36 OTHER NUMBER E%PIRATION DATE <br /> WATERTABLEDEPTII: fl GE PHICALINPORMATION: COOMIDBteT X Y <br /> ❑ PERCTEST R f RUILDINGPERMIT# LAND USE APPLICATION# <br /> ME OF WORK: ❑ NEWINBFA.11UN O REPAIRIADDFFION ❑ ENOm[ERDESIONWALTERNAnvE <br /> O REPLACEMENT ❑ DERDUA710N <br /> INSTALLATIONWII.LSERYE: ❑ REMDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROP LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROFEMPLOVEES: <br /> ❑ SEPTIC TANK TYPFIMW CAPACDY Eel BOFCOMPARTMENTS <br /> ❑ GREASE TRAP IYPFIMFO CAPACITY Rd MOFCOMPARTMENTS <br /> (3 PKG TX PLANT DIBTANCETONEAREST: WELL R FOUNDATION It PROPERTY LUNE R <br /> ❑ LIFT STATION SI2a TYPEOFPUMP ❑ SAND OIL SEPARATOR(P.NGLOSzDSVETEM) <br /> 0. <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS Of LINES LENGTH OF LINES ft 0. <br /> DISI'ANCETONEMuw WELL R FOUNDATION R PROPERTY LINE R CN <br /> ❑ FILTER BED wim R IENGTN R DEPTH R <br /> DISTANCETONRAnST WELL R FOUNDATION R PROPERTY LME <br /> ❑ MOUNDED W..N R LENGTH R DEPTH <br /> DIBFANCETONEAREET --WELL _ 'It FOUNDATION R PROPERTY LANE ft <br /> ❑ SUMPS WIM fl LENGTH R DEPm R <br /> DISTAN[ETONEARETT WELL R FOUNDATION It PROPERTYWNE R Cl DISPOSAL PONDS W:PTx ft LENGTH R DEPTH <br /> DISTANCE TO NEARBBT WELL ft FOUNDATION ft PROPERTY LME fl 1 <br /> ❑ SEEPAGE PITS NUMBER wum, R DEPTH fl IYI <br /> DESTANCKTONEA11E31' WELLft FOUNDATION R PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY .h <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNIY. <br /> MINI MUH R NOT ICE REQUIRED FOR INSPECTIONS I PILE.1ICALL 12091953-7697 <br /> SIGNED TITLE �I�( <br /> C U 3 <br /> NIR N E <br /> L <br /> DEPARTMWIT U E LY '-- —-'"- <br /> 7 <br /> AppLITRtlon Aceepted BY Date 2. C• — 379Arn Employee IDM y <br /> FIeRI I.q.Ion BY DBM 12107 ❑ SPECIAL PERMIT.Approved by <br /> CM1AncHr OESOiII bT33Mr ' •��'i— - i/,,)WuR7p SOLI ChenemF: <br /> COMMENTS C• <br /> s ; N <br /> vw_ y . <br /> PE SC Revel-d hM Amount PetndU <br /> Code INPO B CRPh Reml"Ki DOk S.M.Requimit0 InwbM Peenit WE <br /> A2-02-001 ONSITE WASTEWATER PERMIT <br /> IL 600] <br />