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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAGUM COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 500 E MAIN STREET.STOLKTON CA 86202-(209)468-20 <br /> NON-REFUNDABLE,PERMIT CALL(209)953-7697 FORINSPECTIOON$ _ EXPTRES'I YEAR FROM.DATE ISSUED <br /> • Joe ADDRESS LE, <br /> !L /'>/QAx L' <br /> 1 E CmRP <br /> CROBSST{tEeT APN viC( - 11c Uf' PaiaEL SJZE <br /> OWNER NAME (,I l, "'L !✓E-ST �Z' � L _PHONE �4�K •1H-/`/ :C5a4 <br /> OWNER ADDRE% �T 3 A"� ...�'«C ,.1..1-"T% CITYISTATEMP F.L'e- C Y- ✓F C.f. 4tS4:L. I.. <br /> CONTRACTOR / ' / ��/ �. PHONE <br /> COWRACTM ADDRESS. ' !/Y CITYISTATEMP <br /> LICENSE 4C'42 �I,C46 OTHER NUMBER Li`1JY/> E%Pf"TION:DATE -'"e*,A <br /> WATER TABLE DEPTH: R GEOGRAPHICAL tNFORNATK)N: COOMWIat" X Y <br /> O PERCTEST # �UiLDiNGPEftM7T>X LAND USE AP➢LIGATION)l <br /> TYPEOF WORK: ❑ NEW INSTALLATIONO REPAiR/A001T10N ❑ ENGINES DESIONEDIALTERNATNE <br /> ;yT; REPLACEMENT C DIRAF SEPViCE$EPTIaSYSTEM TA DSE;RWTKI_-- <br /> rWILL SERVE: 'vf RES108MCE ❑ COMMami ❑ OTHER <br /> NUMBEROf LIVMGUNITS: I NUMBEROF BEDROOMS: 4 NUM DER OP EMPLOYES!:.____ <br /> SEPTIC TANK TYPWMFG 111Z CAPACITY /L O gat #Of CoMPuitMENT3 "1 <br /> ❑ GREASETRAP TYPE/MFG CAPACITY Sal #OP COMPARTMENTS <br /> DISTANCE TO NEAREST:.WELT L/{: '6 FOJNOATION /6It PROPERTYLME_f,C ft <br /> ❑ LIFT STATION SIZE. .TYPE OF PUMP ❑ ?KG TX PLANT ❑. SAND OILSEPARATOR(ENCLOSED SYSTEM) <br /> tK LEACH LINES ❑ LEACHINGCHAMSERS le,1, "LINES . LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL 31 it FOUNDAnON tL PROP-WLM— ft �. <br /> ❑ .FILTER BED WmTRft LENGTH It DEPTH R <br /> DISTANCE TO NEAREST WELL. ft EOUNOhnm ft PROPERWINE R <br /> Cl MOUNDED w1aiN R LENGTH R DEPTH 8 ;T <br /> DISTANCE TO NEAREST WELL ft FOLNDATION ft PROPERTY LME ft <br /> ❑ SUMPS WIDTH It LENGTH It DEPTH <br /> 04TANCETONEAREST WELL ft fOLINDATWN. It PRCPERTYUNE It <br /> ❑ DISPOSAL PONDS wwnM ft LENGTH - ft DEPTH R O <br /> • DISTANCE YO NEAREST WELT ft ft PROPERTY Lk�& ft <br /> ❑ SEEPAGE PITS. NVMBEN VADTH 'R [)I It <br /> DSTANCE TO NEAREST WELL _ R FOLwDATON It PROPERWY NE It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL.SE DOME N ACCORDANCE NTH SAN JDAOUINCOUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M/NlMUM 24 HOUR ADVANCE NOTICE RE llIREO Fog INSPECTIONS-PLEASE CALL(2091953-769 <br /> 91GNED .�' TITLE DATE a/+i <br /> \Y <br /> nl <br /> a i <br /> 0 <br /> ¢ f <br /> A <br /> R,171 IV <br /> N 'L <br /> -------------- <br /> i_ bEPARTMEN7 EOkLY <br /> ApphcaNan Aaapt9d Bf+ � -. � _ bate 'I 1 ,Yea Ernpbpaa lD4 5� Qct <br /> Flnal InspectloR 6Y%/�� ' '� fy'' Oete i ❑ SPECtAL PERMIT..ApPTowed Dy <br /> Charecterot SoJIWD1,pthW3FC PI SM P3o6 Character. <br /> COMMENTS U -t F k , i7 - ' 1 '8 - Z-, <br /> P£ IiacelYW AmoPRt PaNR10 fivalae S' Pernil2lD# <br /> • Code Iftltl Csah RamiBMJ DxO. Servke RagueBT'# <br /> 4z-ld Ls a:i. f z .- I( 3 r :SILccG3&� <br /> 42.01 ON6RE WASTEWATER TitTMNTSYSfEMPERM[P <br /> 9tzi7T0 <br />