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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> iAN JOAQVIN COUNTY ENVIRONMENTALHYALTH DEPAR'TMEW 304,E W'ESER.AVE-3"FL-3TOCKTON CA 95202-(209)46&34211 <br /> NON-REFUNI)ASLE PERM CALL(209)"3-7697 FOR INSPECTIONS EXPIRES I YEAR FRom DATE ISbUED <br /> �,. P _ <br /> Joe ADDRESSCT1't'lZIP 2 �11„ <br /> / J v <br /> I CROSS STREETWWr o CT- aD APN t-79-090-0 JQ~ ,�-0^ -` PARCELSIEF.— Oe <br /> OWNER NAME A !� 7 K 1 1 PHONE <br /> OWNER ADDRESS <br /> jgfg ct'j eA CITVISTATFJZH �� <br /> CONTRACTOR <br /> .s7CJ lIV l-/ PHONE FT66�yy,_0_� <br /> RA <br /> COITCTORADDRES5, fV CiTY/ST1ATPI7.IP .� 95 <br /> LICENSE 4.42 0C-36 011JER _ NUMBER ` EXPIRAnON"DATE <br /> WATER TABLE DFA4'H:— __fr GEOGRAPHICAL INFORMATION: Coordi"tes <br /> L( FERCTEST(S) NtlMMR �./ LAND USEAPPLIC-kn0N>E- <br /> TYPE OF WORK: Q NEWINSTAIXATt6N,y+ /a RRPADPJ.0.DD1TlON U £NGINURDD'iRIGNEDIALTERNATM, <br /> �J.�/N RPxt.ACEMENT 1 Ate _ Di1?RtiCTION 1�LlC� i <br /> INSTALLATION'WILL SERVE- wsumKCE U COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS:�� NGMBEa OF BPDROOMS: `�� NUMBER Oe'EMPLOYERS: <br /> XSEPTIC TANK TYPE/Mpo CAPACITY__ Rai S(JFCOMPARTMENVI <br /> a GREASE TRAP TYPVMFG n CAPACITY Sal A OFCOMPARTMENTS r� <br /> ❑ PKG TX PLANT DIsTANC'E TV NEARC5T: WELL f/ ft FOUNDATION f PROPERTY LINE R <br /> ❑ LIFT STATION SIZE_ _ TVPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ;( LEACH LINES W LEACHING CHAMBERS E.0 ,37C7 ..�L-.._. <br /> di OF L.IHTS I ENGTII OF LINES R <br /> DISTANCE TO NEAREST WELL 1_0__-ft FOL'NDATK)N,�_-,__`ft PROPERTY LINE.��,____R <br /> ❑ FILTER BED WnTCH__ ft LENGTH __.A DEPTH R <br /> DISTANCE TO NEARESP WELL ft FOUNDATION ft PROPERTY LINE It. <br /> ❑ MOUNDED WIDTH_.._. _-R LIiNGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL_ R FOUNDATION R PROPERTY LINE R <br /> SUMPS WIDTH It LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL. kQG�- R FOUNDATION r ft PROPERTY LINE + It <br /> ❑ DISPOSiALPO.NDS WwTH-,_ ft LENOTP( __R DEPTH It <br /> DISTANCETO NEAREST WELL. ft POUNDArIONd ft PROPERTY LMIE I't <br /> ❑ SEEPAGE PITS Warm R LENGTH ft DEPTH ft <br /> DISTAXCE TO NEAREST WELL. __R F0LNDAI(O.V__,—_,._-_t7 PROPERTY LIN[ <br /> I HEREBY CBRTIPY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQVIN COUNTY ORDENANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY- <br /> ^,.R! U111 <br /> -A �11N*, NOTICE AEQUIkED FORT t1At�IALEAsE CALL(209)953-7697��� <br /> rfTT <br /> I I <br /> JL <br /> DEPARTMEIrT U ON <br /> Application Accepted$y .. Date d Arra ___ Employes 1DA__�f -.-_._ g <br /> Final Inapactian ByDate - d Q SPECIAL PERMIT-Appro.Kd by 1 <br /> CharacterofSoil to :ef'3Fr• Pi ampSail Character:_�...,..- _...,.__.- <br /> COMMtENTS <br /> I <br /> PE SC Received sskt9l ATme nt Permili avnice III Permit tDs <br /> Cade TNP.D By Rs#liftdu Service u-9400 <br /> 40�Q oa 3 rs— <br /> ' 42-0)-001 ONSITE WASTEWATERPERMIT <br /> 17l1R12 <br />