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ivy <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3"FL-STOCKTON CA 95202 - (209)4611-3430 <br /> NON-REFuNDABLEPERMIT CALL(209)9 7697 FOR INSPECTIONS EXPIRE$1 YEAR FROM DATE ISSUED <br /> JOBADDRESS I-TC, J (.+P�1 {/1CIm//T.+.t1P ' _ N n <br /> CROBSSTREET ,'1 EA [ LS APN M3-1--Jr— I� PARCELSIHH 12 -79 <br /> p <br /> 1 <br /> OWNER NwMC _ PHONE <br /> ESS <br /> OWNERAODRnl�'!, tel• l ."r{ > <br /> �✓ {.�+ Cf1Y1SFATE/ZIY' IL-4 L1� �GC/LJ <br /> CONTRACTOR 'A �f<JL�/K S`/`v S '( ' v FHOne -r' CVC—f <br /> CONTRACTOR ADDRESx CIT'ISTATFJLP <br /> LICENSE M42 OC-36 OTHE NUMBER EXPIRATION DATE <br /> WATER TABLE.DEFTx: A f GEOGRAPNICALINFORMATION: CmrdlnMH X Y <br /> ❑ PERC TE d BUILDING PERMIT 'J LAND USE APPLICATION IS <br /> TYPE OF WO ST NEW InETAW.TION O REPAIR)ADDITION O ENGTNEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL /(� ❑ OTHER, <br /> NUMBER OF LIVIt UNITE: )�/T+ I y NumnERROOFREEOROOMS' --1/�/l/� NUMBER OPEMPLOYEES' <br /> SEPTIC TANK T'PF/MFG F L^ C4�FTLlni C.�' CAPACITY .{ M .I J Sol NOFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPWMFG_ /Y CAPACITY Jf rrG�6 fo LJ Bel NOFCOMPARTMEMH /T�/'� <br /> ❑ PKG TX PLANT DISTANCETONEARESTt WELL lCr ft FOUNDATION ft PROPERTY LINE Ilton A <br /> ❑ LIFT STATION VP <br /> SME TE�OFFPP�UMP /I 13 SAND OIL SEPARATOR(ENCLOSED SYSTW) <br /> S, � <br /> LEACH LINES yy, LEACHING CHAMBERS ECM % ! NOF LIN LENGTH OF LINES /JgC7.( : A <br /> DISTANCETONEAREST WELL f Z) IS tOUNDATION A PROPERTY LINE lhil. It <br /> Cl FILTER BED Wlmll A LENGTH ft DEPTH ft <br /> DISTANCETONEARFST WELL. R FOUNDATION ft PROPERTY LINE A I.4' <br /> ❑ MOUNDED WIDTH _ft LENGIR ft DEFTH R W <br /> DISTANCE TO NEAREST WELL R FOUNDATION, R PROPERTY LME ft <br /> ❑ SUMPS WIDTx ft LENGTH--ft DEFTH ft <br /> DLATANcx:m NEAREST WELL _It FOUNDATION R PROPERTY LME <br /> ❑ DISPOSAL PONDS WIDTHft LnnOrH R DEFTH fl `fTyL�L{II <br /> DIETANCETO NRARn WELL ft FOU14DATDN ft FROPERTY LINE A <br /> J4 <br /> yl SEEPAGE PITS Numen WmTx 4 R DEPTH A �n <br /> DIHTANcETONEAREST WELL ft FJUNDATION ft r ERTY LME A 7T <br /> 11(H/ERR{rEEBBBY�(CERTIFY THAT <br /> IIHAA4VE,PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> SIGNED.��-`"�'L��IM4JR�pURASpFA QF NOTICF.REQUIRE:DFORn STATE LAWS AND RULEA AND WnONS'O'FPSAN <br /> +¢7AS�pTppJOAQUIN <br /> -G1ALL 3091953-7697 ryCCCT <br /> 4 ,rlf.I)"lf(IfLJ(�\t(J\ �'1h,U AL' 1 DATE I" <br /> iv C <br /> A <br /> O <br /> 0 <br /> N P NN E <br /> HL EIS RM <br /> I <br /> D <br /> DEPARTMENT USPONPy _ <br /> ADPlicnllen Accepted DNe Aro �1 Employee IDtl `F <br /> 0 9 <br /> Finel lntpeetionR Dxte SPECIAL PERMIT-Approved by 7 <br /> Chmcter of Suil t1 De hof 3 Fh. Pif/Sunq m <br /> SnB Chehr• <br /> COMMEPIT$ ( KCUv A ' 2 f' <br /> 87 .SQ.. <br /> -------------- <br /> PE SC Ra91vM Cha Amount Mle Perml11 InrokeA Permit lDd <br /> Code ISC. B uh RemIIRd Serrke DeM B <br /> F2.13 11-7 32c.2d bC 'J" <br />