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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY Emmonmem,-AL HEALTH DEPARTMENT I M E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NoN-REFuNoAsu PERMIT CALL(209 <br /> 953-7697 FOR INSPEC77ONS ExPiREs I YEAR FRom DATE ISSUED <br /> Joe ADDRESS <br /> ........... <br /> C4;OSS STREET APN <br /> ........ PARCEL SIZE_:al <br /> OWNER <br /> I <br /> .....--..................... PHONE <br /> i3wNER ADDRESS <br /> :.L_bL_j CrN/STATFJZP <br /> .........................................PHowe ------ <br /> CONTRACTOR ADDRESS .. U1011 CA, c%s2_1t10 <br /> .................................................... <br /> - <br /> LICENSE 1 -42 :,C-36 OTHER- NuusEA aJ i. _EXP7RATKON DATE <br /> ........... <br /> WATER TABLE DEPTH: ft -1EOGAAPHiCALINF0rMATION- Coordinates X <br /> FERC TEST <br /> TYPE OF WORK: NEW INSTALLATION REPAjR/ADtxnoN ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACE NT ....... OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> 114STALLATION WILL SERVE: -p—co—Z OTHER LA <br /> NUMBER Of LIVING UNITS:.. NUMBER of BEOROOMS1._______ NDlivaER OF EMPLOYEES. > <br /> 17 CAPA�-L hzz,., Z_ IC <br /> id SEPTIC TANK T'fpLim';8 0 4 0,CC-PAATMENTS_____ <br /> TY <br /> 0 GREASE WOM, TYFFJMFG gal #0 COMP TME S_... <br /> t'4 'e", CAPACITY r AR NT <br /> DtsuhceToNEAREST WeLL It FOUNDATiON It PRoPFATYUNE <br /> 3 LIFT STATION SWE ............................ Type OF pump ..................Cl PKG TX PLANT 0 SAND 04L SEPARATOR(ENCLOSED SYSTE#A) <br /> U LEACH LINES 7 LEACHING k OF LINES LENGTH OF LINES s S IT <br /> DISTANrETO NEAREST 'WELL It R)UNOATI0N.__.____ft PR4OPERTYUNE___it <br /> CJ FILTER BED WIDTH.................__ ft LENGTH DEPTH It <br /> DISTANCE TO NEAREST WELL—__ It FOUNDATION---tt PROPERTY LINE. <br /> WIDTI,____it LENGTH it DEPTH <br /> OW4NOr TO_ZEAREST WELL.._...__.......__..._............ft FOUNDATION _it PROPERTY LINE <br /> QK sumps WIDTH 't LENGTH it DEPTH <br /> 11 FOUNDATION it PROPERTYUNE-_ It <br /> 0 DISPOSAL PONDS WmTij it LENGTH ...... _f2 DEPTH It <br /> DISTANCE TO NEAREST WELL........ it POUNDATION__—fit PROPERTY LINE ft <br /> 5L SEEPAGE PITS NumsERI <br /> AL-1cl— Wor-____3...........—,,--it DEPTH It <br /> DISTANCE TO NEAREST WELL AC- It <br /> 'HEREBY CERTIFY THAT I PAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS Of SAN JOAQUIN COUNTY. <br /> A41AIlMUM 24 HOUR ADVANCE N077CE REOVIREo FoR#VSpgrT7QNS- ALL PLE41SE 0 95 69 <br /> j(2 09 3-7 <br /> SIGNED ....... ... TITLE <br /> —----- DATE <br /> _T <br /> s t7 <br /> _T <br /> it:L <br /> _77 <br /> T <br /> 7' <br /> -t ti--- <br /> 1 <br /> D EP A R T,4 E JV r U S E'Q N L V <br /> AgpHeation Date_1; '21-Cc Area EmployaeID*Jl 'art,ti' D <br /> Final Inspection B Date /AI, 0 SPECIAL PERMIT-Approved by <br /> Character of sou to of 3 Ft*--- 7 PidSoil Character <br /> COMMENTS <br /> D, iw <br /> PE SC W4id k Anwunt I P"mit/ <br /> I D invoice 4 pormit IDS <br /> Code INFO ev ash Remitted Service Reauest <br /> ONSfTE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4,24112 <br />