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ONSPITE WASTEWATER TREATMEN'MSTEM PERMIT <br /> AN JOAQUIN COUNTY ENVIRONMENTAL HFALTN DEPARTMENT 3W WEBER AVE- -FL-SFOCLTON CA 95202-(209)C6&3120 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INNPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS D <br /> I1/1/!•I CRV/ZIP F 3J�S V`PO <br /> CROS6 STREET APNAl3 -/30- i7 -PFARCELNV.E p� g <br /> OWNER NAME PHONE 0.09��EI S- bG1f <br /> OWNERADORM -N 'C4 CITY/STATE/ZIP <br /> CONTRACTOR N -1H� PNONE <br /> CONERA-AOR ADDRESS CITY(STATE/ZIP <br /> LICENSE ❑C-42 0C-36 OTHER NUMBEp ^` <br /> EMPIRATION DATE <br /> WATER TABLE D[TI: 1 Y fl GEOGMPNICAL INPoRMATION: Coordinates % Y <br /> ❑ PERC TEST(S) NUMBER LANA USF.APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION O ENGINE[RDESICNEO/ALTERNATIVE TV) <br /> REPLACEMENT 13 DESTRUCTION <br /> INSTALLATIONWILLSERVE: RESIDENCE ❑ COmrAeaanL ❑ DITTIES -J <br /> �C NUMBER OP LIVING UNMS: q I NUMBER OF B[DROOM3: �f L' NUMBEROFEMPLDYEES: <br /> JJ\ SEPTIC TANK T <br /> PF/MFG (`AT'2C M_ CAPACITY 1200 PI #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPF%MFG CAPACITY y RSI #OFCOMPARTMENTS mV <br /> ❑ PKC TX PLANT—DISTANCE TO NEAReBf: WELL ���• fl FgIHOATIOryH PROPERTY LINE & e1 fl <br /> ❑ LIFT STATION SIZE TYPEOPPL'MP O SAND OIL SEPARATOR(ENCLOSEDSySEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS pOPLINES_ r LENGTH OP LINEE <br /> DISTANCE TO NEAREST WELL fl FOUNDATION fl PROPERTY LINE fl <br /> ❑ FILTER BED WIDTH It UNGTH It DEPTH fl <br /> DISTANCETONEAREST WELL H FOUNDATION H PROPERTY LINE fl <br /> ❑ MOUNDED WIp" H LENGTH ft DOTS It <br /> �I DLSTANCETONrTEAREST WELL ft FOUNDATION H PROPERTY LINE fl <br /> WRITS SUMPS WIDi- H LENOTH I X It OErtx 7 fl <br /> / DISTANCETONEAREEP WELL�CJ A FOUNDATION /h H PROPERTYLINE fl <br /> ❑ DISPOSAL PONDS WIDTRI ft LENOTH fl DEPTN H <br /> DISTANC TO NEAREST WEU. fl FWNDATpN fl PROPERTY LINE fl <br /> 1 SEEPAGE PITS WIDT= fl L&NOTIi n DEPTH— fl <br /> —DROANCETONEAREST WELL DATION A PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OR SAN JOAQUIN COUNTY. <br /> IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(201))953-707 <br /> SIGNED' TITLE, DATE L O <br /> S-V AV <br /> 1� <br /> I� <br /> kTPi it m Fm <br /> (r <br /> rIo 7 <br /> lk <br /> . A RoW ow LyT <br /> I n 8'MI r it Bn <br /> I s a xr- <br /> T <br /> u <br /> DEPARTMENT U)C ONL# �/ y/ <br /> Appikatbn Accepted B C Date A. , Employee IDM oty y��y <br /> Final lveplRtbn By - Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil IS Oe of 3 FL• PIU mp&oil Ch..Nr. <br /> COMMENTS 4, 0�oc->C X74 Itj Alt.11 DL'73 y <br /> PE Sc ReeNved • ecldl/ A. I Mte PerndU Invoice# Permit IDM <br /> CMde INtA) B ReMIDed SarvlceR BeH# <br /> 7 '!/ © rplD 3 <br /> Allaz Ia9I ^ �1 a?.�I� I`l '/9An7 /ddlG/1 ' LIuf3 N <br /> 13/LN3 aWP-S9k/�E(J iT/��"M <br /> � '�A-1";'* ff 3 ZO"C4_4(.����%B'�oASTEWATER PERMIT <br /> QaW.b"C$!+}!//rOli.3dic�JYLY bL-LZc�FQtr Y"�FTF2/Y/F'P Twp A'MC - moi <br />