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ONSITE WASTEWATER TREATMENT SYSTEM PERM�C�E R.�I 'xz2 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENTER <br /> . JUIEWEBAVL-Ive FL-hTOC <br /> NON-REFUNDABLE PERMIT CALL 2 53-097 FOR INSPECTIONS EXPIRES I YEAR f"DATE IssUED <br /> ca <br /> �7J90 Wesf MoSSdPF/g ems✓ cm/zIP /.o-fL P <br /> JOBADDRPss ^/y n�7 4 n Qr <br /> T S APN )7 V.1 C7c�_ PARCEL SIZE�� g <br /> Ca113s STREET <br /> OWNER NAME U1Jn&(1-4e PH"E-?=0.3- 5GpG� <br /> OWERADDRESS cmmAmDr �MA RICN /`� r <br /> p%� <br /> ^r33r6 <br /> CONTRACTOR PHONE <br /> CONTRACPDRADDRESS CTM1'/STATEIZIP <br /> LICENm: CI C42 E3 C-36 OD1ER NUMBER EXPIRATRIN DATL <br /> WATER TABLE DEPTH: fl GEDGRAPHMALINPORIATION: CDor,r0itea X. Y <br /> ❑ PERE TEST pBUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 0- MMI.LLATION ❑ REPAIR/ADDFrH)N ❑ ENGINEERDERCNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER • <br /> NUMBER OF LIVMG UNf13: __ � NVMBER OIIP BLDROOM3: NUMBER& EMMAVEFS: <br /> SEPTIC TANK TYPFIMFG CArw(/j y�.I PSI l� CAPACITY I2-0 V Bel NOFCOMPARTMENTS Z- <br /> ❑ GREASETRAP 7WE/MFO CAPACITY Bal pOFCOMPARTMENTS <br /> ❑ PKG TX PLANT DIWANCETONEARGST: WELL�r R FOUNDATION I1� It PROPERTY LINE I V + R <br /> ❑ LIFT STATION Sim TYMOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSER SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS paLMEs LENGTH OFI-mm R V1 <br /> DISTANCE W NEAREST WELLft FOUNDATION ft PROPERTY LINE R <br /> FILTER BED Wim 1 n �R LENGTH I rft DEPTH '!Ilioft <br /> DLSrANCETON[AREST WELL NA R FOUNDATION Imo' fl PROPERTY LME ft <br /> ❑ MOUNDED WIDTx ft LENGTH IN DEmH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LME ft <br /> ❑ SUMPS WIDTH ft LENGTH fl DEPTH ft <br /> Dur ANCETONEAREST WELL ft FOUNDATION R PROPERTY LME fl <br /> ❑ DISPOSAL PONDS WIDTR ft LENGTH ft DEPTH ft <br /> DmANCRTONGRESr WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ SEEPAGE PITS NUNUNR WiarR R DEPT" ft <br /> DIWANCEWNEAREST WELL fl FOUNDATION fl PROPERTYLME ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE M ACCORDANCE WITH BAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF BAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)957-7697 <br /> SIGNED /CTITLE CJr•-f�9 NTJJ� DATE -0S� <br /> S-5 INI.-w 0 p <br /> Ib U6DanvM9li la�l <br /> Tar 50 <br /> T <br /> 0 D <br /> o64¢RVATgn roRR � I B AREn <br /> K ZS' >) <br /> PLAN. \\ D f <br /> IY'� of(ii.e <br /> oi.Mmlmo aum -1��, O4� <br /> cr MlmrlruHamrm�van <br /> TN .a R ,... .�_�A,,..®P. <br /> � MW _ eP� tiry <br /> DEPARTMENT USZ ONIL <br /> Application Aceepe, Date L O <br /> FinalbB DatM❑ SPECIAL <br /> PECIAL/A PERMIT <br /> ERMIT- mplmeT `- <br /> ry <br /> Chancier Df Soil b De of3 FD Plt/SRmp Soil Character: 'r <br /> COMMENTS $ to <br /> -- okPv--5 (.B L TAIL �" u iJ s — z+LQ,(. AToUT ram i Dds <br /> PE I SC Receive, h Amount Date POrMD Iawin, Permit Im <br /> CacheInro B Caeh Remined SerYbe Re uestp <br /> 14Z <br /> 42-(Q 0l ONSITE WASTEWATER PERMIT <br /> 12RSrz9D <br />