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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENY1R0:4MENTAL HEALTH DEPARTMENT SBCE WFAER AVE-P"Fl.-Sl0[:l(TON CA 95202 -(209)668-}120 <br /> NON-REFUNDABLE PERMIT CALL. 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRECmIZIP <br /> SS <br /> ` CRQEE STREET ,Tyrat'h Ga tf API 2-C-3 "L'`(C C'j PARCEL SIDE l<y•(I $ <br /> v <br /> Ac <br /> ^ � n �r j7 eY.1PHONE <br /> OWNER NAME 1 <br /> OWNER ADDRESS Ah..C/ _ CFfYISTATULP <br /> Ir <br /> CONTy .L r J c PHONE <br /> MCFOR <br /> CONTRACTOR ADDRESS Y CITY/STATPJZIP - <br /> LICENSX ❑C-A2 ❑C36 OTHER NCMBER EX%MnON DATE <br /> WATER TABLE DEM;- CEOGIUPHICAL INFORMATION: Co"Now X Y <br /> ❑ PERCTEST Y BUILDINGPERMIT# -LS r -S LAND USE APPLICATION# <br /> TYP£OF WORK: ✓a New lnerntunon' ❑ RErA1WADwnOn ❑ EnanEEaDESIQ\ED/ALTeRNAnve <br /> ❑ REPucEMEM' O DESTRUCFION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL <br /> q <br /> O/ ❑ OTHER <br /> ^ NL'MBEROFLIN'ING UNITS: NUMBER OF BEDROOMS: J NUMBCR OP EMPLOYEES: <br /> SEPTIC TANK TVPFIMFG L CAPACITY I(. M1LN Bel BOF COMPARTMENTS�� <br /> ❑ GREASE TMP TYPEIMFG CAPAcm Sal YOF COMPARTMENTS <br /> ❑ PKG TX PLANT DIETANCETOINPAREST: WE" 0' 7 ft POUNDATM ir� �( Il PROPERTY LINER <br /> ❑ LIFE STATION Su TYFEOFPumP ❑ $AND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> IN <br /> i H <br /> tldJJ <br /> LEACH LINES ❑ LEACHING CHAMBER$ YOFLINES LENGTH OF LINES r <br /> DHTAKETONEAREST WELL_W'r ft FOUNDATIONi11�ft PROPERTY LME?�� R (. <br /> ❑ IQLTERBED Wm'rx R LENGTH fl DEPTH ft <br /> DLITANCETONEARMT WELL R FOUNDATION ft PROPERTY LINE ft h <br /> ❑ MOUNDED w1n,. ft LF.NITII R DEFTH ft <br /> DISTANCETONEAREST WELL ft FMNMATION ft PxOPERTY LINE R y <br /> ❑ SUMPS WIDTH R LENGTH R DEFTH ft WP <br /> DISFANCETO NEAREST WELT. fl FOUNDATION ft PROPERTY LINE <br /> fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEFTH ft <br /> DISTANCETONEARFET WELL ft FOUNDATION fl PROPERTY LME ft <br /> f <br /> [Y SEEPAGE PITS VtmnER 3 WIDTH ?y6A H DEPnl l+`( Ri. .t <br /> DU'GNCETONEARE4T WELL 1011 ft FOUNDATION li.)l R PROPERTY LINE qu I R t <br /> I HEREBY CERTIR'THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DON E IN AOCORDANCL WITH SAN JOAQU1 COVMTV L <br /> ORDINANCES,STATE LAWS AND RULFS AND REGLEATIONS OF BAN JOAQUIN C%NTV. <br /> MIN1.1UM NtMLR ADVANCE NO'1'iCE:KEQUIaED PURINSPI:(TONS-PLEASE CALI.12D41953-7647 <br /> TITLE !2 rQ^Z,=f4M _ DATE <br /> FT IiiiiiiIIIIIIIIIIIII <br /> 1 <br /> TY <br /> IR N <br /> /JE DELYRTMENTE'S O \' <br /> Applieetion Accepted C-.C.L Date tt (SJ C S� Area EmPIDYa IDYLA q <br /> Fleet IRFpdtlon BVDate /1—/' ,t&C5 13SPECIAL PERMIT-Approved by <br /> Chander of gull to DeDTh of 3 Ft: 414me <br /> PHISump Soil Chander: <br /> COMMENTS <7i,F <br /> . _S FGCf AZIv_rs-;;i �Q <br /> PE SCReceivN CSdWI; AmWal PermiU InwiteY Peron IDO <br /> Code Inro B Reatifted DaY SeZRego <br /> eaY <br /> C: <br /> 42-021101 ONSITE WASTEWATER PERMIT <br />