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�o <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3"111-STOCK'rON CA 95202 -(209) 68-M20 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEA FROM DATE ISSUED <br /> JOSADDRESS �3!/(/y //C T�� k/�' CITVILIP Y�/pCl,/-e Q S��O L <br /> CROA STREET / J �H/raNT 2.D APN ®,2IGSO-99` —i PARRCEELSnI <br /> QNNER NAME _ VQGj a//�iZ_i/ PH,O�NNE -2.0/ -�f/— ��I <br /> OWNER ADDRESS 7i O /Y• CrrY/STATEIZIP A I*f [?14 �a`J <br /> CONTPArTOR //� PHONE O <br /> COMMCFOR ADDRESS CRY/STATE/21P *J <br /> LICENSE 0CA2 0C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE MIMED: R GEOCRAPHICALINFOINATION: Cooedipalm <br /> FERC TEST p rBUILDINC PERMIT# LAND USE APPLICATION#—Z� <br /> TYPE OF WORK: ❑ NEWMSI'ALL.ATION O REPAIRIADDDIOrI ❑ ENGINFF.RDESIGNED/ALTERNATME <br /> O REPLACEMENT ❑ DFSTHUCr10N <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL L3 OTHER <br /> NUMREROF LIVING UNITS:_ NUMBEROFHEJURNERS: NUMBEPOFEMPLOVEDE <br /> ❑ SEMC TANK TYPE/MFG CAPACITY Set #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MF* CAPACITY gal NOFCOMPARTMENTS <br /> ❑ PKGT PLANT DISEANCE TO VEAREBr; WELL ft FOUNDATION R PROPERTY LINE fl <br /> ❑ LIPTSTATION Sizr TYPEOFFUMe ❑ SAND OIL SEPARATOR(ENCLOBED SvIrvw) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS OOFLm _ LETOTHOELIRES ft W <br /> � <br /> DISI'ANCETONEAREBr WELL ft FDIINDATvN ft PROPERTY LINE ft qR <br /> ❑ FILTER BED WID'rx R LENGTH _fl DEPTH it C. <br /> DISTANCETO NEAREST' WELL. R FOUNDATION fl PROPERTY LINE 11 <br /> ❑ MOUNDED WIDTH ft LENGTH fl DFPDI ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LME <br /> Ll SUMPS WIDTH R LF.NGtH R DEPTH ft <br /> DISTANCETONEARESr WELL R FOLfNDAT1ON R PROPERTY LINE ft <br /> 13DISPOSAL PONDS WIDTH It LENGTH R DEPTH ft <br /> DISTANCETONEARL4e WELL ft FOUNDATION a PROPERTY LINE ft J <br /> ❑ SEEPAGE PITS NUMBER Wmrx R DEPTH <br /> DISTANCETONGRE6T WELL [L FOUNDATION ft PROPERTY LINE R ` <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ml <br /> ORDINANCE%STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 1% <br /> NIMUMI OUR ADVANCE NOI'I CE REQUI RED FOR INSPECTIONS-PLEAS/e Cµ',AL12091953-7697 <br /> SIGNEDit/ TIME (��/ LXSIN'ILaNBATE ��� <br /> C ILA I - I w <br /> �I <br /> 1 Nrl <br /> I <br /> t I <br /> I lid <br /> rSDTI <br /> 77 er <br /> "NA��tt �° 5 <br /> �...,. TA <br /> .--ria Our <br /> r �— <br /> • <br /> DEPARTMENT E NLV <br /> Appliealioe Ae<epW By a D.le 1J Ds• Ara Employ«IDp <br /> Final Impecdo.Ey / Dale � ❑ SPECIAL PERMIT-Appmved by <br /> Cluramrr of Snil 1R Deptb N]PL PiUSump Soil character: <br /> COMMENTS <br /> PP. SCRettivetl Eecloof Amount Permit/ <br /> Cade INFO a RemittedGale SerNce Request 0 nvokep Peruse lDp <br /> Vz.Fz szr �HZZ 3'72.Gi1 [ Os 700 7 <br />