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fJ3a ONSITE WASTEWATER TREATMENT SYSTEM PERMIT a <br /> QUIN COUXTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBSRAVE-3"FL-STOCKTON CA 95707 -(709)46"20 <br /> FUNDABLE PERMIT.2-f 00 Z LL 209 953-7697 FOR INSPECTIONS EXPIREI YEAR FROM IIATE ISSUED <br /> JOBADDRM U O CITY/ZIP f PLJi✓Y1Q 41^- /✓ ate- a <br /> • CROMSTREET SA R�✓<F'H><A�7/L/]� Ie�d) APN LPY`II-�./G�-l7 PA <br /> RCELSIZE <br /> OWNERNAME e2 J t ri /i'/I A e74Z2 L PHONE + <br /> OWNER ADDRJO S CTTVJSTATFJZIP <br /> CONTMCT011 PHONE - S <br /> CONTRACTOR ABDRPSS - ✓ CmJBTATFIT.IP <br /> LICENSE C1 C42 OC-36 DINER NUMBER -C 4.5-`S EXPIRATION DATE_ <br /> WATERTABLE DEPfH:_ It CEOGGPMICAL INPORMATIOX: COOrW.tna X Y <br /> ❑ <br /> PER C TEST p BUILD/NC PERMIT IV LAND USE APPLICATIONS <br /> TYPEOF WREPAIPJADDITIOXORK: D NEW INSTALLATION ❑ D ENGINEERDESI ..ALTERNATIVE <br /> REPLACEMENT I--EN[.k rtE40 D DFATROCDON <br /> INSTALLATION WILL SERVE: 0 RMDMcL 13 COMMERCIAL CIOTHER_ <br /> NUMBEROF LIVIN�GGsUNrITU NUMBEROFBEBIMOM8: NUMBER OF EMPLOYEES. <br /> ❑ SEPTIC TANKC�rfYPEJT'Mro� CAPACDY J77-G GI gal p W COMPARTMENTS <br /> ❑ GREASE TRAP TYPUMFO C/EAQIY S.I #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OFPIIMP ❑ SAND OIL SEPARATOR(ENCLOSEDSVBTEM) <br /> y➢ LEACH LINES ❑ LEACHING CHAMBERS pOFLWES^j LENGTH OF LINES It <br /> DISGNCCTO NEAREST WELL R FOUNDATION__R PROPERTY LWE R J <br /> �LTER BED WIMP ft LENGTH --EatT- ft Dam <br /> DISTANCE TO NEAREST WELL /Ar+ W R FOUNOATION ft PROPERTYLINE R t� <br /> ❑ MOUNDED WW" H LENGTH R DEPTH R <br /> DISTANCETONEARLST WELL_ ft FOUNDATION R PROPERTY LINE It L <br /> ❑ SUMPS W." ft LENGTH ft DEPTH It <br /> DISTANCETONEARPST WELL_ It FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTM n LENGTH fl DEPTH fl <br /> DJJTANCETONEAREFI' WELL__11 FOUNDATION fl PROPERTY LINE fl <br /> ❑ SEEPAGE PITS NUMBER WmeN R DEnn ft D <br /> • DISTANCETONBAREET WELL R FOUNDATION R PROPERTY LINE R +� <br /> INERERYCERTIFY ATI HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WVIM SAN JOAQUIN COUNTY <br /> OaOJNANCBR STATE LAWS AND RULES AND REGULATIONSOPBAN JOAQUIN COUNTY. <br /> IINI M a HOUR AUV ANCE NOTICE REQUIRED FOR INSPECT/IONS-PLEASE CALL(709)953-7697 Q <br /> SIGNED TITLE_ I T 14J-aC-/V, DATE 2-- 1-0. <br /> tiff I <br /> t <br /> 11 L4 <br /> UI <br /> 57 W1 N rEP T <br /> J - - <br /> I <br /> DEPARTMENT U EO LY 1j <br /> Appiic.tioa Ac=VW lL'r DBM Cf G•S A. 2.1 EDlpleyaim 53(96 /14� <br /> PI..I IBµHRRen 0.w 4Z///44— ❑ SPECIAL PERMIT-App VxI by <br /> CE.ncrer ofSONM DW6 af3 Pc PI�UBa1Rp Sol[CBFFReRr. <br /> COMMENTS AJCw cT of RFc o.A4 1 -7_ .s- /O <br /> • -f�lLtlAl /�t3�I. �/3fyTSL.tom.-r�rG�2221581� � <br /> PE SC Rsm1ATd CB Amovat Perm1U <br /> Cuda INro B Rab RM.RW MUService uwltl IavWce9 ParnIR lDp <br /> IF2.lJ Its '6 62'� l,Pv.ca3 q D <br /> A3-03LEI ONSGEWASTEWATERPERMIT <br /> I]nL1WJ <br />