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ONSITE WASTEWATER TREATMENT SYSTt=M PERMIT <br /> BAN JOA N COUNTY ENNRONMENTAL HEALTH DEPARTMENT <br /> 800E MAIN STREET-STOCKTON CA 9$202-(209)46a-3420 <br /> NON-REFUNDABLE PERMIT ;C84(209)953.7697 FOR'INSPECTIONg EXPIRES 1 rEAR FROM DATE I UFD <br /> JOB ADORE87' <br /> CROSS STTtM_TJ lel S f 3S APN �.— D -- �C2. <br /> / r ��fp <br /> OWNER NAM! K / 1 PNON! <br /> OWNER AODREEa �� It�L + •_Crn/STATE/Z,P <br /> CONTRACTOR_ 1�p <br /> �j PHONE / <br /> CONIRACTORADDRISE I O�� r ��yII 6 :Cm,/gTATE/ZIP Sa /III <br /> Ltt¢wsE LTC a2 ❑Cas OTEtFJt J NUwBIR3.2f?3__TXP1RATIONDATE <br /> WATER TABLE DEPrm, ft GEOGRAPHICAL INFORMATION: Coordinat" X y <br /> 0 PERC TEST A—� BLILDING PERMIT# LAND USE APPLMATION# i� <br /> TYPE OF WORK: G NEW INVAttAT70N C REPA*AzJb oN O ENGINEER DESIGN[D/ALTERNATrvE <br /> n REPLACEImNT C DEBTRUCTION Nj <br /> INSTALLATION WILL SERVE: 0 RESIDENCE ❑ G OTHER <br /> NUMBER OR LfMG UNITS: Nn E ' NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPElNFG AP 4 000 gal #OF COMPARTMENTS <br /> GREASE TRAP TYPEIMFG CMAC 031 #OF COMPARTMENTS <br /> 01STANC[TO NEAREST: WELL R FOUNDATION it F'RODERTY L04E _ R <br /> L1 LIFT STATION SIZE TYPEOF PUMP O PXGTXPLANT E3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> IN <br /> LEACH LINES O LEACHING CHAMBERS r� NOF LT'ES � LENGTH OF LINES s? ft <br /> DISTANCE To NEAREST WELL�%N'� A FOUNDATION u '4 R PROPERTY UNI: <br /> O FILTER BED vhm It LtNGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION f! PROPER-y LINE n <br /> ❑" MOUNDED WROTH ft LENGTH __ ft DEPTH R <br /> DISTANCE 70 NEAREST WELL It FOUNDATION_ ft PROPERTY LINE—_,_ ft <br /> O SUMPS WOTM ft LENGTH - ft DEPTH ft <br /> DISTANCE TO NEAREST WELL -_ ft FOUlMATTON R PROPFRTY I 14 R <br /> D DISPOSAL PONDS 7MDT4 ft L&4um ft DEPTH__ ft <br /> DISTANCE To N9ARmsT WELL ft FCUN77ATION }( PROPERLY LINE ft <br /> SEEPAGEPITS NUMBER_ ��^ liyalTw 36 _eft DEPTH 2 S ft <br /> DISTANCE TO NEAREST -WELL E-10"_ft FOUNDATION O ft PROPER-Y LINE <br /> I HEREBY CERT7 TVA T EWPRIPARE.11IS APPLCATION AND THE WORK WALL BE DONE IN ACCORDANCE WITH SAH JOAOUW COUNTY ORDINANCES, <br /> EWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> DVANCE NOTICE REQUIRED FOR INSPECTIONS- � �E([�AIL(209)95]-7897 <br /> SIGNE .TITLE /,Wi('tTr DATE �J <br /> I I i II r FT <br /> I I � <br /> I <br /> I <br /> I <br /> C_WIF <br /> - - - <br /> I <br /> ' I <br /> I I <br /> - j { <br /> I <br /> I � 1 <br /> A <br /> - P <br /> EPARTMEN U O Y LCf�-— ^7 <br /> Appllcat{on Aooepted Data Area Employee IDI! <br /> " <br /> Final Inspection By Data ❑ SPECIAL PERMIT-Approved by <br /> Chametor of Soll to Depth of 3 Ft: Nt/Sump BOI7 Doer: <br /> COMMENTS <br /> PE SC Received Amount errnlV <br /> Carlo 1 IwrO A I Cash Remltled � cervico Ra u / Irwoice* Permit IDD <br /> I <br /> Z G 3 Q 5 y <br /> 42-01 ONSITE WAST"EWATE!t TRYMNT SYSTEM PERMIT <br /> I af4J07 <br />