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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT �'1 <br /> SAN JOAQUIN CouNTV ENVIRONMENTAL HEALTH DEPARTMENT 304EWEEERAVE•3-FL-SracxTQNCA9520J-(209)X68-3/20 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR 1NsPEcrloNs EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS .7,90 WeSf MOSsn1,3LA- ,2a✓ Crrvr[mP LCJ9yAT ,o <br /> CROEE STREET 1 J o AIN Z .I QV. (01) JS PARCEL SIM. S <br /> OWNERNAME aaWw,l[-(•e R-Z(�eLie.f0 WW11PHONEE 209- JP2--999C? <br /> OWNERADORE49 f.e)-F/0nx�I9D•' CITY/STATErLIP /T?AIlIC" 16f - � —336 <br /> CONTRACTO0. jo PHONE 2,92J LJ -I <br /> COHTRACTORADDPFS'S CITY/STATFILIP <br /> LICENSE 13 C-42 Ll C-36 OTHER NUMBER EINWTGN DATE / <br /> WATERTABLEDEPIR: ft GEOGRAPHICALINPORMATION: C"MiMUet X Y <br /> ❑ PERCTEST M BUILDINGPERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: Ili— NEWINBI'ALIATION ❑ REPAIR/ADDRION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER O <br /> NUMBEROP LIVING UNM: �A NUMBER OF BEDROOMS: NUMBEROPEMPWYEFS: <br /> SEPTIC TANK TYPr m C� cfl r�Lr P� (._ CAPACITY 12.0 r) gel NOF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPF/MfO CAPACITY Sal NOFCOMPAETMENTs <br /> ❑ PKG Tx PLANT DIBTANCETO NEAEMIN, WELL a ft FOUNDATION I g� ft PROPERTY LINE I Q-r ft <br /> ❑ LIFE STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYBrBM) <br /> ❑ LEACH LINES O LEACHING CHAMBERS N OP LMFS LENGTH OF LINES R <br /> D16TANCETONEAREBI' WELL A FOUNDATION R PROPERTY LINE ft <br /> FILTER BED Wim in, ft LENGTH � A DEPTH 'M R <br /> DUSTANCETONEARE6T WELL�R FOIINDATON ID R PROPERTY LMft <br /> O MOUNDED WIDTH ft LENGTH R DEPTH R <br /> DISTANCETONEAREEr WELL R FOImDATGN ft PROPERTY LINE R <br /> O SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DOPANCETONEARETT WELL ft FOUNDATON ft PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPT fl <br /> DISTANCETONEARESf WELL ft FWNDATION It PROPERTYLME ft <br /> ❑ SEEPAGE PITS NUMB. WU,H ft DEPTH ft <br /> DIBTANCETON.IIESr WELL ft FOUNDATION ft PROPERTY LME R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAX JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIN UM IX HOUR ADVANCE NOTICE REQUIRED FOR INSPECCTIONS-PLEASE CALL(2N)951-7697 <br /> SIGNED I C TITLE C.D,6-e-foA- DATE 7—(2-oS" <br /> N 1--�°. ► S"g 1 . <br /> vPmaooan�� \ . <br /> 7.10QwirnVlloNe <br /> AD <br /> 5 m <br /> T <br /> ip' o <br /> oMERVATION eORIP E AkSh <br /> /3 <br /> PLAN. <br /> N__ <br /> - DEPARTMENT US ONL O <br /> - AppNsaHen-Aaep4d - Dv4 I -L A Arn ]��. ..Empinyee�Ul �� <br /> Pinel IropectbD a Pf DRIB ❑ SPECIAL PERMIT•APProf2d <br /> Chmrter of Soll to De Df3PG PlvSump_SoI1CMrurer: <br /> COMMENTS C ,-L�,_N .S 1^eerT Fa4Ld L2e ➢'Pwx ID <br /> 1412-31145M W <br /> CJ /T-IofJ 6 J7-d+ PLS 7 <br /> PE SC Rettived R AnJouD[ PerIIdU <br /> Code Ingo B GJh Remittetl Dvk SerWttR umtX InvekeN PerN11DN <br /> -30 <br /> 4b0 ] ONSITEWASTEWATENPERMIT <br /> 12OL2003 <br />