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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAI:JOAOUI N C UtirrY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON Av £-ciwexTON CA 95205-(209)468-3420 <br /> NowREFUNDABLE PERMIT CALL 209 953-7697 FOR IANVTCTA)NS EXPIRES 1 YEAR FROM DATE ISSUED <br /> c C C - <br /> 7�AOOREss ^CITY _ .. .____.._._____..__._.._.-- ."-� <br /> r�-.- PARCEL SLZ£_._ '� c <br /> CROSS STREET _..,.._.,.�-� .__ APIC___..._ "- <br /> z <br /> OWNER <br /> (J 3fA" <br /> O.In ADL1HE5S _3 C7iMC�+" ......_._...._.._.. —______..._._..._._.__.._.—:_CI IISTA'i'I--Ml �y� �w <br /> CONTRACTOR ,°L c, >�.*, {l�rLrJw �> ••__.._.._,._.________-P1i9NE �....--k �L.rlY+3 <br /> CONTRACTOR AOGRtE88 - 7G.JGTIS I..fJ f__, CIY1STAT£IL1P <br /> ..LICENSE '.-C:C-d2 Cf-C-36 OTHER..._.- _ NUtaeER,`�! ExP'rR�tT'roNDATE �aj <br /> WATER TABLE DEPTH: l; GEOGRAPHICAL INFCRmTION: Coordinates X..._..w. .. �' <br /> j :i FERC TEST # Btt1L17tIG PFstauT# LAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION REPAtl1/AMMON Ci ENGINEER DESL73NED/ALTERNATIVE <br /> 0 REPLACEWNT _ OUT-OI:-SERVICE SEPTICSYSTfw to DEmucnoN <br /> i1I TALLATICSI WILL SERVE: - i,7 CowaRCIAL j n OTHER <br /> NuIIiHBft OF L2VING UNITS;_.,-,__ ...�.. titUtlB'EA�866ROV.S:,- _ IuaiBER OF Ean W'Ew. <br /> SEPTTCTANK TYPEIMFG PfL - CAPACITY_r- tY"b gal #OFC0WARi'T..TS_2__ <br /> E3 GREASE TRAP TYPFJMFG -_ q. CAPACITY Tat #OF COMPARTMENTS <br /> DISTANCE-to NEAREST.* WELL -.--_ It FOUNDATION �i��,.°, it PsOPEtRTYUNE <br /> Q LIFT STATION SIZE TYPE OF PUMP— 0 PKG TX PLANT Ct SANDOIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES Z. LEACHING CHAMBERS #CIF LINES_ -._..' LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL. , '" _-it__FOUNDATION Vt)l ._.....It PROPERTY ii It <br /> 13 FH-TER BED 1NIon+�.._.— #i LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL__..._._It FOUNDATION It PROPERTY LINE R <br /> Q MOUNDED WvYtm_ _--"_-_ �It LENGTH -� it DEPTH- - it <br /> Dtou"M TO NEAmST WEU.,.,._,,.,.,._,..__..__......It FOUNDATION -,it PROPERTY LINE It <br /> C2" SUMPS WwH R LENGTH_ it DEPTH It <br /> DISTANCE TO NEAREST WELL ."„-_. it FOUNDATION it PROPERTY LINE_ it <br /> LSI DISPOSAL PONDS WIDTH It LENGTH_--------____ it DEPTH R <br /> DISTANCE To NEAREST WELL It FCAMOATCN It PROPERTY LINE.._-._... _It <br /> C k SEEPAGE PITS Nuuarsa ,_ WInTy __ _ _ _ It .DEPTH_ it <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE. It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL Be DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND RECULATIONS OF SAN JOAOUIN COUNTY. <br /> tlYI <br /> NUM24t UFt bV 11GE N07=REWIRED FOR)MSPEC77t7lU5-P"SASE BALL 209 y1r5�3-71597 <br /> SIGNED....._......._..-....-.___.__.... ._......._.............. TITLE_ d<:I^ �"+ .s%" _ DATE <br /> i <br /> 14 1,71 <br /> fa <br /> 1 <br /> I ' i <br /> r <br /> 11 i <br /> i <br /> Applicatfon Accepted 8Y _ ..- Date 1 14- Area��� I rnployee IDS <br /> F#iW Inspection By .✓'';�, r Date. L _ Cl SPECIAL PERMIT-Approved by <br /> Character of Soh to 01 Ft ltlSump Salt character! <br /> COMMENTS_. jai � ���, (' . I k4,5 � �,a t 1 � ,r 1�/41 f`l 1 i tom, <br /> + 3'E SC Received Check#t Amount Data Permiv Invoice# Permit ID* <br /> f Cade INFO Remiit Service R..1# <br /> 42p5 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 41',>1e7t2 <br />