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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALT' '-YARTMENT 304E WEBER AVE-3"EL.STUC'—NCA 9520]-(209)46&3438 <br /> NON-REFUNDABLE PERMIT 'CALL 209 953-7697 FOR INSPECTIONSEXPIRE' R FROM DATE ISSUED <br /> C <br /> JOBADDREBE F F L11)E / CFFYIZIP / I j <br /> CROMSTREET LA,yyu 6I Rcacl APN G :'3-daC�-.G3. PARCEL SIZE e <br /> OWNER NAME MY- {BUY vAilf APHONE 1_ <br /> OVFNERABWEBE �- CITY/STATF/11P /YC Twp(; CA q6•J C) <br /> CONFRACDJR I_ 1 P\ PHONE GI <br /> CONTRACTOR ADORERS ') (' .l CriMSFATFJZIP G I <br /> ` LICENSE CI C42 ❑Cdfi OTHER NUMBER ERPIMTIONDATE <br /> WATERTABLEDEPEH: ft GEOORAPHICALINFORMATION: CooAtnetef X V <br /> O'. PERCTEST # BUILDINGPERMIT# LAND USE APPLICATION#PA—OZ-CECe L <br /> TYPE OF WORK: ❑ NEW INS'TALIATION ❑ REPAIR/ADDRION ❑ ENGIREURDESICNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DPSERU=oN <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUNUEROFLIVINCUNTIS: NUMBEROFBEDROOMS: NUMBEROF EMPLOYEES: <br /> ❑ SEPTICTANK IYPSI Q CAPACRT gnl #OFCOMPARTMEHTS <br /> r ❑ GREASE TRAP. TYPE/MFG CAPACITY gel #OFCOMPARTMENTS <br /> ❑ PKG TX PLANT DIErANcBTONEAREEr: WELL ft FOUNDATION - R PROPERTY LINE ft <br /> ❑ LIPT STATION SITE TVPEOFPUMP ❑ SANDOILSEPARATOR(ENCLOSEDSVSEEM) <br /> ❑ LEACH LINES ❑ LEACHINGCHAMBERS #OFLMEB LENGTH OF LINES fl v <br /> DIETANCLTONEARFST WELL R FOUNDATION R PROPERTY UNE ft <br /> ❑ FILTER BED WIRTx R LENGTH R OEM ft <br /> DISTANCETONEAEFSr WELL ft FOUNDATION It PROPERTY LME fl <br /> ❑ MOUNDED WmTx ft LN BUl ft DEPTH ft <br /> DLSTANCETONEARL4T WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ SUMPS W. ft LENOIR R OEM ft <br /> DISTANCETONEARFbT wEW. R FOUNDATION ft PROPERTY ONE fl <br /> r ❑ DISPOSAL PONDS W. ft LENOTN - ft DSM fl <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LDrE fl <br /> ❑ SEEPAGE PITS NOME. L ft DEPTH R <br /> DISFANCETONEARE4E WELL R FOUNDATION A PROPERTYLNE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> I� MIN MU.hS�.E�HO-�LLRAD�'ANCE NOTICE REQUIRED FOR INSPEC(TIONS-Pl, ASE LL(209)953.7697 !r <br /> SIGNED, `ti TITLE 1 LII SUI Ic7! DATE+/ <br /> 2 <br /> IBR <br /> C <br /> ` n1,C <br /> 1 <br /> aL . <br /> av $AN JqAC Alc u <br /> NT <br /> DEPARTMENT SE LY s �(/� <br /> PPII (' <br /> AuHpnn Am,W BY N&e <br /> ��-.^i A� EmPloya IN <br /> Final lmalion By DRh ❑ SPECIALPERMIT-Approveaby <br /> r CMRnrhr Of 591110 Dep[h of3 FR PR/Somp SoIICWnMr: <br /> COMMENTS <br /> r <br /> BE SC Reuived ChmWH Amount M4 PerMtl InvoWM PerWtID# <br /> Coae IxTD B Reminea SeMee uatM <br /> r zol <br /> Ll-0]-001 - ONSITE WASTEWATER PERMrt <br /> ILL IO <br /> B. <br />