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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 3(W F Wf,$#.R AVE'-3-FL-STOCKTON CA 95202 -(209)468-M.20 <br /> NON-REvuNDASLF PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE l,,;SLFD <br /> JOS ADDRESS <br /> meyw,�vt Q Cava)P 2jemt-tt <br /> CROSSSTAKET APN, -fit <br /> PARCELSIZE <br /> OWNER NAME ld Ac)Wen. <br /> PHONE <br /> OWNER ADDRESS CMISTATFJ7AP <br /> CONTRACTOR A PHONE. <br /> CONTRACrORADDRESS__. <br /> LICFNSIF, QC-42 J-36 OliqEk............... Numarst <br /> WATER TASLE DEPTH: ft GWGRAPHWAL INFORMATU)NZ Coordimatti X y <br /> ETEST IT#—.�D f,-e� LAND USE APPLICATION 4�E� --jt�t5-�j. — <br /> TYPE OF WORK: NEW INSTALLATION U RMIPJADINTION J KNMNEERDa1,GNEoYALT <br /> REPLACEMENT J Dr.,;TRvcT1ON <br /> INSTALLATION WILL SERVE: zal RESIDENCE COMMERCIAL CYPHER <br /> Ntmsr.RoPLivmcUmTs: Num1wst OF BEDROOMS: Nt?m&cROFE.MPI1qVXvS! i 'Ar'.Lo <br /> 341EPTIC TANK CAPAM Y PI #OFCOMPARTMENTS_:�_ <br /> CJ GREASE TRAP TYffJ%rlFr CAPACITY PI *1)FCO.MPARTMENT;S_,__, <br /> CI PKGTXPLANT DISTANCE To NEAREST* WELL--��14'- ft FOUNDATION ISI ft PROPERTY LINE <br /> It <br /> LIFT'STATION Slat— I-Ypc()I'PUMP U SAND OIL SEPARATOR(ENCLosto SYSTEM) <br /> W'LEACH LINES EIr<EACHINC CHAMBERS j 14 4 OF Lm-s LENGTH of LINES 00 <br /> DISTANCE TO NEAREST WFAA. ft FCXNDATtON, ft PROPERTY LINE <br /> C1 FILTER RED W10TH <br /> ................................ DEPTH ft <br /> DISTANCE TO NEAREST WEU it FOUNDATION ft PROPERTY LIMP Pt <br /> 3 MOUNDED W,...........(I DErI)i <br /> DMANCETONEAREST WELL--It FOUNDATION ft PROPERTY UNE ft <br /> 3 Sumps w1orm <br /> L- .............. 11 LENGTH DEnH <br /> DISTANCE To NEAREST WELL. A FOUNDATION PROPERTY LINE <br /> 0 DISPOSAL PONDS WIDIN ft <br /> LENGTH It MPTH <br /> DISTANCE TO NEAREST WFLT,----ft FOUNDATION ft PROPERTY LINE -ft <br /> 0 SEEPAGE PITS N(,MSXX__WmTiR DEPTH It <br /> D(SrA.NCFTONEAREST WELL P. MUNDATK)Nft PROPERTY LANE It <br /> I HEREBY CERTIFY THAT I HAVE PREPARXI)THIS APPLICATION AND THE WORK WILL RK DONE INACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND RCCVIATIONSOF SAN JOAQUIN COUNTY. . <br /> j Z4 HOUR ADVANCE.NOTICE;REQLIkEf)F0kIN'SPI,.CTIO%S-PI.EA'f(AJ.1.1209)4534697 <br /> SIGNED Tau, 6�nirn,,+ur DATE,4, 1 <br /> 14 <br /> A 1-j <br /> -1 T- <br /> I L 7 1 <br /> I T <br /> yl 1 <br /> J <br /> EPART.MFNItjSE(,)'%I,V -1v <br /> Application A Date Area Employee IDO <br /> Final Inspection 0 SPECIAL PERMIT-Approval by <br /> Date* <br /> Character of SoilBtyoy� of�3F Ft: C,�g...... <br /> COMMENTS Pit/SanV Soil Churamm <br /> -21 At <br /> PE SC ReeeYvtd Amooat pern6v <br /> N1 w <br /> C.& INFO a Cush.... Remitted Date Service Rectu"t N Invoke 00 Pern-al ID4 <br /> 2,60 <br /> k cm I <br /> ............... <br /> ............ <br /> ONSITE WASTEWATER PERMIT <br />