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' d ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SM JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCHTON CA 95707-(709J 468.3420 <br /> ' NON-REFUNDABLE PERMIT CALL(2091953-7697 FOR INSPECTIONS EKPIRES/�77 YEAR FROM DATE ISSUED <br /> JOB ADDRESS E. .H CRYaIl w -157 b j <br /> cRosssTREEr r.J (Y7S7r APN PmeaLsvil dg <br /> OWNER NAME E.- 'l7 Ir PHONE <br /> ' OWNER ADDRESS` { CRYISTATERIP �da�e�..rc fr 95 23b <br /> CONTRACTOR IV 0 K l I C PHONE + ` Q <br /> ' conTRAcrae ADDRESS Cl a2 moi,. <br /> SQA zI CRYISTATEl .0 <br /> LICENSE QCJ2 QC46 OTHER NDMBER EKPRAmNDATE <br /> WATERTA OWWI ft GM'GWMCALINPORMATION: COOrOinStlS K - Y 0 <br /> ' PERC TEST #_2__ 1 BUILDING PERMIT# LAND USE APPLICATION# �CL5- <br /> TYPE OF W ❑ NEW INSTALIATIOH ❑ REPAM/AODIO 7 ENGINEBR DEBIGIIen IALne THE <br /> ❑ REPLACENEm ❑ DESTRUCiMNI 1-0 <br /> ' INSTALLATIONWILL SERVE: LJRPRRIMNR ❑ COMYERCML 72OTHER <br /> l NUMBER OF LNND UNITS: �— NUMERfIPBEDROOMS: NUMBER OFEMPLOYEEB: <br /> ® SEPTIC TANK TYPeNFG CAPACITY gal #CFCOMPARTMENTS T VIII <br /> 0 GREASE TRAP TYPERJFG CAPACITYgal #OF COMPPRTMENTi_ <br /> ' DISTANCETONEAREST: WELL It FOIINOATION ft PROPERTY LINE ft <br /> 0 'LIFT STATION SIZE TYPEOFPUMP O PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0 LEACH LINES ❑ LEACHING CHAMBERS #OFLINES LENGTHOFUNM ft <br /> DISTANCE W NEAREST WELL X FOUNDATION ft PROPERTYLINE ft <br /> O FILTER BED WITH It LENGTH fl DEPTH ft {� <br /> DWAN69 TO NEAREST WELL X FOUNDATION X PROPERTY LINE ft <br /> ® MOUNDED WIDTH ft LENGTH fl DEFTH X <br /> DISTANCE M NEAREBT WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O sumps Wim X LENGTH X. DEPTH X <br /> DISTANCE TO hlf a WELL it FOUNDATION X PROPERTYLINE R a <br /> 0 DISPOSAL PONDS Wim ft LENGTH it DEPTH It c}/ <br /> ' OISTANCETONEAREST WELL 11 FOUNDATION fl PROPERTY LINE It <br /> ® SEEPAGEPITS NUMBER WIDTH ft DEPTH R Ji <br /> DISTANCE W NEAREST WELL ft FOUNDATION ft PROPERTY LINE It J� <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL Be DONE IN ACCORDANCE WITH SAN JOAGOIN COUNTY ORDW ES, `d <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY- <br /> FOR INSP CTIONS-PLEAAE CALL(209)953.7897 <br /> SIG TITLE <br /> J-04 <br /> FGG HLTIXV]0.i.1N.R.Y..H0.atY. <br /> O_ <br /> Ihrrl�u V"V <br /> BNt <br /> y9 $ <br /> _ FC <br /> E ENT 1 .-. T <br /> Application Aoeap - - - Data ZT 0 Ami Employee ION TU��a 4y <br /> Final Inspection B Data 4ZU ? ❑ SPECIAL PERMIT-Appiquad by <br /> Character of Soil to pth Of 3 Ft: PIUSump SWI Chander: <br /> COMMENTS 17/— g--' .t/'ixCg?: ef.t� M 3 JA^-,S--24- 03 !12776 3 <br /> PE SC RxelNed Amnunt w.' Permhl Imaice# Permit iOY <br /> C. INFO <br /> Cash Rand IDe nest# <br /> 5aS SZs.aJ 9 <br /> ' 4MI G/ ONSITE WASTLWATERTRRRJT SYSTEMPERMR <br /> 1014N7 <br />