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f ONSITE`` JJ.STEWATER TREATMENT SYSTEM RMIT / 'V <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL�LTH DEPARTMENT 3"E WEBER AVE-3'`NIgIlISTOCKFON CA 95202 - (209)46 3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JORADDRIW /T-)�- CJm^mP y <br /> CROW STREET �✓ �� // ��A�PPNLgS�IDV� �� PA�RfCEI.SIZE z/J/ O <br /> OWNER NAME )✓!-TAA d// d&Alf— dt eZ4[ •� PHONE �zJ�-7 1974pY <br /> OWNER ADINIM _J CmISTATEUEIP / <br /> J <br /> CONTRACTOR R x PHONE j <br /> CONTRAC'TORADDREAS C.IRTATFlLIP <br /> LICENSE OC42 [3 C36 OTHER NUMBER / EVIRATION DATE <br /> WATER TABLE DEPTH: ft GEOORAPNICALINFORMATION: CNITIHNIt" X Y I� <br /> ❑ PERC TEST N BUILDING PERMIT III LANDUSEAPPLICATIONB \ <br /> TYPEOPWORK: NEWINREALUTION ❑ REPA1./ PWIII N ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: LI RESIDENCE TY�y-CommERCIwL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBERWREDROOMS: /� NUMBER OF EMPLOYEFSL <br /> SEPTIC TANK TYPFIMFG E'� CAPACITY f&W R01 NOFCOMP"TMENTS Z <br /> ❑ CREASE THAT TYPFJMFG CAPACm Eel NOFCOMPARTMlNTS <br /> ❑ PKG TX PLANT DISTANEETONEAUEST: WELL R FOUNDATION ft PROPERTY LONE R <br /> Cl LIFT STATION SIU[ TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLOWDSYSTEM) <br /> 1 <br /> LEACH LINES ❑ LEACHING CHAMBERS koF LRJFS LENGTH OF LINES �OC/ ft <br /> DISTANCETONEAREST WELL ft FWNDATWN ft PRor..IL.E R <br /> ❑ FILTER BED "mix ft LENGTH R DEPTH fl <br /> DISTANCETONEAREST WELL fl FOUNDATION It PROPERTY LINE fl <br /> ❑ MOUNDED W.. ft LENGTH R DEF H fl <br /> DISTANCETONEAREST WELL A FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WHEN ft LENGTH ft DEPTH B <br /> DISTANCETON"REST WELL It FOUNDATION D PROPERTY LINE fl <br /> Cl DISPOSAL FONDS Wmtn R LENGTH fl DEM ft <br /> DHTANCEMNGRmr WELL R FOUNDATION It PROPERTY LME fl <br /> ❑ SEEPAGE PITS NDMsu WmTX ft DEPTH fl <br /> DISIANCENNEAREST WELL ft FOUNDATION fl PROPERTY LINE fl <br /> 1 HEREBY CERTIFY THAT I HAVE PREPAREDTHIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULED AND REGU"TIONS OPSAN JOAQUIN COUNTY. <br /> MI/NII M24 kDVANJ.K NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2011933-76,97 <br /> / <br /> SIGNS 'a ' / "y - TITLE. /J DATE <br /> e <br /> JI) <br /> I <br /> p U111 C U <br /> IR <br /> G <br /> DEPARTMENT USE V ��� �� ',Py/�y� <br /> Applir tion Acte Date Arco Employee IDA <br /> ph..1lnyectb BY ..G�r �' Date - /<TIYYn ❑ SPECPERMIT PERMIT-Appy by <br /> ChmaEter.= p1ho Fc Pi"Imn,Soil Che. 15>O� <br /> COMMENTS <br /> 106k fA2 AfiElo./ 5h!%%H 144.> 1111-ii.s - t2-PI /6cv�2-z <br /> PE SC Re«!vN C Idl! ANSI Dale PE k Permit IDN <br /> Code INPD B wJNJtk4 Servke umlN / .moi <br /> Vib Vie <br /> 0( / <br /> 42N-051 ONSITE WATTEWATER PERN!IT <br /> I l3 K0) <br />