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OONSITE WASTEWATER TREATMEOYSTEM PERMIT <br /> SANJOAQUI. COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AI'E-3-FL-STOCKTON CA 95202 -(209)4683420 <br /> NON-REF N'DABLE PERMIT CA L(209)953-7697 FOR INSPE('TIONS EXPIRES 1 FROM DATE ISSUED <br /> JOB ADDRES m)C er CITY/ZIP I nYP'1 G <br /> n + � rI <br /> CROSS$TRC '1/11 fLQ '/Pyr 1 APN��-��oy PARCEL SIZE �� <br /> OWNERNAN „•I�rgT tz, .A (k r`o- C/ /.SP1}HONE do� r/6 3 <br /> OWNERADD ESS V'I""✓' •I �I LCITY/STATE/ZIP /"•�pl�l 14 ' <br /> CONTRACTO `"�I I I 'I S{+/Tf/i-��' " ' PNON/E &A)"'I y !"�� -(yJ� - 517 <br /> 01 <br /> CONTRALTO ADDRESS •I (' ' l CITY/STATEIZIP <br /> LICENSE C42 0C-36 OTHER NUMBER ESTIMATION DATE <br /> WA ERTAB EDEPTH: R GEOGRAPHICAL INFORMATION: C.Ordinal¢s X Y _ <br /> ERC EST(S) NUMBER LAISTUSEAPPUCATIONrY r /( <br /> TYPE OF RK: ❑ NENINSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESICNEDIALERNATIVE <br /> ❑ REPLACEAIEfiT ❑ DESTRUCTION <br /> INSTALLA IONWII.L SERVE: ❑ RESIDENCE (3 COMMERCIAL ❑ OTHER <br /> NUMB R OF LIVINCUNITS: NUMBEROFREOROOMS: Nu,mwROFEMPLOYEES: <br /> ❑ <br /> SEPTH TANK' TYPE/MFG - CAPACITY gal M OF COMPARTMENTS <br /> ❑ GREA TRAP TYPEIMFG CAPACITY gal 4O COMPARTMENTS �•i <br /> ❑ PKGT C PLANT DISTANCETONEAREST: WELL R FOUNDATION It PROPERTY LINE R ` ' <br /> ❑ LIFTS ATION ',,.SIZE T'PEOPPUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEN) �) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS MOF LINES LENGTH OF LINES It C <br /> DISTANCE TO NEAREST WELL R FOUNDATION fl PROPERTYLINE R <br /> ❑ FILTEi t BED WIDTH R LENGTH R DEPTH (i <br /> DISTANCE.TO NEAREST WELL R FOUNDATION R PROPERTY LINE__ R y <br /> CJ- MOUN ED WIDTH R LENGTH A DEPTH it - 'Y <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION R PROPERTY LINE R 3 <br /> ❑„SUMP WIDTH R LENGTH D DEPTH fl <br /> DISTANCE TO NEAREST' WELL ft FOUNDATION R PROPERTY LINE ft <br /> O DISPO ALPONDS WIDrx R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft ! PRQFERTYLINE _it <br /> ❑ SEEP EPITS WIDTH, - R LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTI'LISE p p <br /> r IHEREBYC RI IFA THAT I HAVE PREPARED THIS APPLICAT ION AND CITE NORh N11L BE DO'Ell ACCORDANC1:N'FTAbAN JOAQLI N CbGTTI ORDIf,A,1CLS 1' <br /> k. STAT P LIN 5 AND RULES AND REGULATIONS OF SAA JOAQUIN COLAT 1. <br /> t N 11UUH 24 HOUR ADVANCE NOIICP R4�IIRIDFORISSP CII NS:-PLEASECILL <br /> 99 <br /> MINED I:� 1�rLS", 11 � ieaDA,�( j', <br /> '( <br /> ea � . <br /> z 70, <br /> c ! 1 a <br /> r° .1r(99 ^•_ Ig, . 6rsS G_— �,�q((�-cr�9�.v��1�/�n I ii c •`i <br /> ISC �. r � $�. I .0 cI <br /> AS z E g <br /> .fff99 .0169 N.Ip.W h .[t'lr9 M !0 U <br /> ,10'9pr .1010 W O IL80r <br /> t=; , _ v 4 A <br /> Til- ii i it to l <br /> h SA <br /> N IH N <br /> H EP RT E <br /> ( DEPARTMENT L)m O.' V <br /> rZ ..1 — eam /// v ' 3 Arca .:3/' . EmPmyee lD4 <br /> Application Accepted By r« <br /> - Final Inspection By Dale ❑ SPECIAL PERMITApprovedby <br /> Ch1CUTdrof Solltogflrof3FU PIV$umJl Sbill araclet: <br /> COMMENTS <!IG - 7T1[.rUa c�/�/v/T e:. .1"'(rx"T Pl a..�'0 ,� �S��rIOLI UTI) <br /> PE SC Received Amowt - Pe <br /> Code IHPO By_ Cash my d D vi Invaaep Permit IDM <br /> Ya <br /> I <br /> ODAO 1 <br /> Il::^J02 ONSITE WASTEWATER PERMIT <br />