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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH OF TENT 301E WEBER AVE-3'IR-STOaKTO' 95102-(209)468-3430 <br /> NON-REFUNDABLE PERMIT L 209 953-7697 FOR INSPECTIONS EXPIRES I OM DATE ISSUED p <br /> JOBADORFSE l:, CcG ^J. �41` "I' Cm21P 'TI:EY IY.'YT.'Y� de,`. M <br /> 1 <br /> CROSS STREET f-: r L. 1� APN 00{- O-1 D - C`a PARCELSIEE <br /> 2 <br /> oWmEa NAME �Yta�, 1va�\ = p�I�E. �- 4 Rel <br /> OWNER ADDRESS <br /> CCO3 /J. V&11 Q Bn fC 3J'L Cm/sTATPILIr <br /> CONTRACTOR jVIGI{ C'. r�11fLCYS;�- r\C-.t C {r� PRONE <br /> CONDVATORADDRess ` 4'It U Yln, 1 - CmISTATUZIr - <br /> V <br /> LICENSE ❑C42 ❑C-36 DTHPA NUMBER EXPIRATION DATE <br /> WATER TA.DMH: R GE.00MPHICALINF011MATION: Conr01nEk1 X Y <br /> FERC TEST Y BUILDING PERMIT# LAND USE APPLICATION# <br /> 6. TYPE OF WORK: ❑ N.INSPALIAT10N Ci REPAIR/ADDITION O ENGINEERDFSIGNEDIALTERNATIVE <br /> ❑ REPWCEMENT ❑ DimuLTION <br /> INSTALLATIONWILL SERVE: ❑ RL9IDENCE ElCOMMERCIAL ❑ OTHER <br /> NUMBE0.0P LIVING UNITE: NUMBEROFBEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK WIEN CAPACITY gil #OFCOMPARTMENTS <br /> ❑ GREASE TMP TYPFJMFG CAPACm pl Y OF COMPARTMENTS <br /> ❑ PKG TX PLANT DIEFANCETONEARJE1N WELL R FOUNDATION R PROPERTY LINE ft <br /> i <br /> ❑ LIFT STATION SITZ TYPE OP Pu F ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) O <br /> ❑ LEACH LINES ❑ LEACHINGCHAMSERS #OFLRdS LENGTOFLRJEE R <br /> DISTANCETONMREET WELL R FOUNDATION R PROPERTY LINE fl <br /> ❑ FILTER BED Wo. IN IdRORI R DEPTH fl <br /> DISMNCiIMNEAREST WELL ft FOUNDATION R PROPERTY LME <br /> ❑ MOUNDED WIDTH R LENGTH ft DEM It <br /> DUTANCETONMREAT WELL R FOUNDATION R PROPERTY LINE R - <br /> ❑ SUMPS WIDTx ft LEN ITH R DEPT R <br /> DISIlANCETONEAREST WELL fl FOUNDATION R PROPERTY LME R � <br /> ❑ DISPOSAL PONDS Wlmx ft LENGTHR DEMft %- <br /> DIWANCeTONEARPST WELL ft FOUNDATION R PROPERTY LME It <br /> ❑ SEEPAGE PITS NDMBER WIDTH R DEPT It <br /> DIWANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ` I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE T ACCORDANCE WITH BAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF BAN JOAQUIN COUNTY. <br /> MINIMUM N HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)95}-7697 <br /> ___. ('.. { _ l.. .. / C' <br /> LSIGNED TITLE 1 1 GATE h1< t <br /> PtJ� <br /> Y T <br /> C <br /> A <br /> #+ <br /> 'EPAR'TNIENT USE RLV <br /> Application Accepted BYI � r ale-- 6 J Aru Employ=ID# <br /> Flnvl Inspection By Dale ❑ SPECIAL PERMIT-AppoYe by /N <br /> Chander cf Soll to MIDI of l FC PiDSomp Soil Cbarecter: <br /> COMMENTS <br /> PE SCR Vw Cbee r Alnvpvt W P. Iii <br /> Code DRD B =U.:d .Dvk BeMmR< xnt# IDwkep Permit lDp <br /> 21 7/(- 13 D S 5 Z I <br /> 42­02001 ONSITE WASTEWATER PERMIT <br /> IN VXD <br /> i <br /> 6B <br />