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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL RGLTH DWARTMEW 306E WEBER AYE-3RD FL-STOCKTON CA 95202 -(209)468-3620 <br /> V NON-REFUNDABLE PERAU CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS CrYmp / <br /> CR0a9 STREET APN Z 1;.. - : "I —/�G a E <br /> 1 � PAJWEL SIZE�L" Ppp+ <br /> ` OWNER NAME �I P�`r�,¢i !`^!-�-V, ('FC .5-PUoNa-v BI �' �.77,C;- L41.,2 C6 <br /> OwNER ADDREM ( , ` �A"/n' S C w�1, -r CPTV/STAIE/Lly ( c C- c ^ 1 `/� <br /> CoNTNACTOR -� ^ - PHONE 1L y <br /> ` CORTRACTOR ADDRF95 ClWISTATF/ZIP <br /> WcRQR ❑C42 3C-36 OTHER NUMBER ExPIRAnon DAre <br /> WATER TABLE DEPTH: fl GEOCRAPNIGLINFORMATION: COOMinatee X Y <br /> F2 FERC TEST k BUILDINGPERMITA LAND USE APPLICATIONM <br /> .TYPE OF WORK ❑ NEW INBIALIAnON ❑ REPNUTADOITION ❑ ENCMEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTR .. <br /> INSTALLATION WILL SERVE:' ❑ RmumPCE ❑ COMMERCIAL ❑ Orem <br /> i NIIMBEROP LIVMG UNITE: NUMBEROPBEDRoOMR: NUMBEROFEMPLOEEE4: <br /> ❑ SEPFICTANK TYPE/MCAPACITY SBkoFCOMPARTMEMS <br /> ❑ GREASETRAP TYPF/MFG CAPACITY eel IF OF COMPARTMENTS <br /> ❑ PEG TX PLANT DiTrprvaioNuRemr: WEU, It FOUNDAT*N It PROPERTY LINE fl r) <br /> r ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ SANDOILSEPARATOR(ENaoseo SyIHn Q Z <br /> ❑ LEACH LINES ❑.LEACHINGCHAMBERS koF LINES LENGTH OF LM R 1 <br /> DISFANCETONEABEST WELL R FOH?UF.ON fl PROPERTY LME R y <br /> ❑ FILTER BED Wien; R LENGTH fl DEPTH R C <br /> Bxa DISTANCE TO NEAREST WELL R FOUNDATION R PROPERMLME ft S <br /> ❑ MOUNDED WIDTH fl LENoiR R DEPTH ft r <br /> DISTANCETONEA. WELL fl FOIMUATION R PROPER'LINE <br /> ❑ SUMPS W. fl LENGTH ft DEPTH ft V I <br /> See DISTANu TONEARERT WELL R FOUNDATION R PROPERTY LME ft <br /> ❑ DISPOSAL PONDS WmYR fl LENOTH fl DEPTH fl 0 <br /> DIETANCETONEARESr WELL R FOUNDATION R PROPERTY LME ft <br /> ❑ SEEPAGE PITS NUMBER W. It DEPTH R r-�- <br /> DISTANCE TONUEEST WELL fl FOUNDATION R PROPERTY LME R r <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE M ACCORDANCE WITH SAN JOAQUIN COUNTY 1 <br /> ORDINANCES SATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY: <br /> ��� }K • .b MINIM HHOUR AOYANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALyL(20�9)053469 <br /> SIGNED TITLE` _ -. -. \ DATE �- <br /> i u.rnaw•unnJ sinew e�.m I i <br /> 6. <br /> 1 8& pA C B <br /> €z xnsior: O O1 IIN <br /> S E V <br /> AA 911 BE]ff- <br /> V I <br /> I <br /> DEPARTMENT USE ONLY <br /> APpllevtlon A.. By / ,1 � _X Date UIS(G'( Arm Emplo ION AC, �Gr. <br /> FIvvl lnspu0on ey Date ❑ SPECIAL PERMIT-Appmvedby <br /> Character of Soil W DePlh of3 FL• PRISRmp Soil Ch.,.h r: <br /> Nee COMMENTS <br /> PE Be ReeaivN Anmear P.PmiU <br /> C.& INTO B Carh ReMHed MIe ServluR umlk Inveieek PermillW <br /> beeZ2 dl N i'121;1 1 k,, R16-5 ` (Or 1l a <br /> I <br /> y�mT ONSOE WASTEWATER PERMIT <br /> Ir <br />