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ONSITE `WASTEWATETREATMENT SYSTEM PERMIT <br /> B AN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1e 306E WESER AVE-3-FL-STUCKTON CA 95201"...""')061-3020 <br /> .(YON-REPUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS p�1 IRES I YEAR FROM DATE(ISSUED <br /> JoBADINERS 'Ll-51720 Ow IP vim.' I� j <br /> :ROWSTREET TII'f' APN G7_I-Zoo-2Z- PARp <br /> CELSIZE-al: kp <br /> WNER NAME P II PHONE ' <br /> OWNER ADDRES4 P 9 t+.;,_ 2IN F) Le�T� AIC 41 CITV/STATFIZR <br /> :orcrRAcroa e�I U c e S PHONE <br /> CONFMCTORADDRE31r� ) CITY/SIATE/ZIP L+A' C Z O <br /> ACENSE LJ C-42 ❑G36 OTHER NUMBER EXPIRATIONDATE <br /> VATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: Cintdhnln X Y <br /> PERC TEST # 2 BUILDINGPERMIT# LAND USE APPLICATIONth- <br /> TYPE OFWORK: ❑ NEW INSTALLATION ❑ REPAIR/ADOTION ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> NSTALLATION WILL SERVE: 13REsIDENCE ❑ COMMERCIAL ❑ OTHER <br /> I-- NUMBER OF LIVING UNITE: NUMBEROFBEDROOMS: <br /> NUMBER OF EMPLOYEES' <br /> ❑ SEPrIC TANK TYPEIMFG CAPACHY pl #OF COMPARTMENTS `\ <br /> J GREASE TRAP TYwMFG CAPACRY. gel #OF COMPARTMENTS IJ <br /> rJ PKG TX PLANT DIBTANCETONGRF_4T: WELL ft FOUNDATION R PROPERTY LINE ft s``1 <br /> ❑ LIFT STATION SITE TYPEOPPUMP 13 SAND OIL SEPARATOR(ENCLOSEDSYSTEM) Jv <br /> _ Q <br /> ❑ LEACH LINES ❑ LEACHINGCHAMBERS #OFLwEs LENGTH OF LINES ft <br /> r <br /> DISTANCE TO NEAREBT WELL ft FOUNDATION ft PROPERTY LINE ft ,1 <br /> ❑ FILTER BED WIDIN ft LENGTH ft DEPTH <br /> DUTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME R <br /> 7 MOUNDED WIDTH ft LENGTH i ft DEPTH R `. <br /> r DIWAFCETONLAREST WELL R FOUNDATION ft PROPERTY LME ft <br /> (3 SUMPS W. ft LENGTH ft DEPTH It <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LME R t <br /> 7 DISPOSAL PONDS WIBTH ft IENmH It DEPTH It <br /> r DISTANCETONGBEBr WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER wIVTx ft DEPTH - R <br /> DInANCETONEAREST WELL ft FOUMATEIN. ft PROPERTY LME- ft <br /> r I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN]OAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF BAN JOAQUIN COUNTY. <br /> MINIMUM 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE\CALL(209)953-7697 <br /> SIGNED I - TITLE DATE <br /> OSM, I_ <br /> 4. <br /> ILNPIEl6 NEMR1d5 - <br /> PAY 4.. <br /> UPI <br /> DFPARr1U1T1SItl7) L1/ <br /> Penal Inipection HY Dat,_ _ ❑ SPECIAL I+LHMI T-App nvcd by <br /> Character oTSoil to Depth of3 FC _. ___ PIUSoon,Son]CI actgn <br /> COMMENTS <br /> P� sc— 6e m An. r Dam P 'N mPomea PermalD6 <br /> cone 1Neo H It Ren Intl Service Ke est# <br /> I 6 <br /> -_ <br /> ONSITE WASTEWATER PERMIT <br /> 'ic22i00] <br />