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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT c'q�. <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AYE-3'°Fl.-SPOCKTON CA 95202-(209)468-3420 <br /> ?YON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADDREss Sn.( 6 3 FAA.,-rJ CITYIZIP 84 kd l - <br /> CROSS STREET APN R:77-24oc-5,.3 PARCEL SIZE 2-f Q(_ • e <br /> KL„�-d- o�G� <br /> OWNER DAME L PHONE <br /> OWNER ADURESS CTIY/STATEIZIP r •• <br /> CONTRACTOR q44 I,%s-G.- Jc f. PHONE SSb <br /> CONTRACTOR ADDRESS CITY/STATFJZIP <br /> LICENSY ❑C=.2 ❑C-36 OTHER NUMBER EXPIRA ON DATE_ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST a_ BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: Awr New INSTALLATION ❑ REPAiPJADDIT{ON ❑ ENGINEEa DESIGNED/ALIYRNATTVE <br /> ❑ REPLACE'MGYr ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 43-WSIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROFLIYINCUNTTS:_ l NUMBER OF BEDROOMS: 3 NUMBfAoFEmPLoYEES: <br /> VSEPTICTANK TYPE/MFG__i-¢'L CAPACITY jj t-OQ gel 4OFCOMPARTMENTS <br /> ❑ CREASE TRAP TYPFJMfG,^-_ CAPACITY gal �#OFCOMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL �O I ft FOUNDATION `!Di _ ft PROPERTY LINE aX f ft <br /> ❑� LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ZV LEACH LINES ❑ LEACHING CHAMBERS1 <br /> #OF LINES LENGTH OF LINES <br /> DISTANCETO NEAREST WELL fp'7' —ft FOUNDATION ~�f�it PROPERTY LINE ( fl <br /> ❑ FILTER BED WIDTH ft LENGTH _ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ R PROPERTY LME ft <br /> ❑ MOUNDED WIDTH ft l,r_NCTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 13r . <br /> SUMPS WIDTH fl LENGM ft DEPTH fl W <br /> DISTANCE TO NEAREST WELL _ft FOUNDATYJN ft PROPERTY LINE ft Q <br /> ❑ DISPOSAL PONDS WlunT ft LENGTH ft DEPTH fl <br /> ,- DISTANCE TO NEAREST WELL _ft FOUNJ�TION ft P�OPEReT�Y LINE <br /> Q- SEEPAGE PITS NUMBBR .� WIDTH { �p ft DEPTH .iS/ fl vv <br /> DISTANCE TO NEAREST WELL-1 4LQLs R FXNDATION Inn' ft PROPERTY LINE A.-Sj ft 11�, <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK W ILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY (` <br /> ORDINANC FA STATE I,A WS AND RULES AND REGU LA TIONS OF SAN JOAQUIN COU NTY, <br /> MINIMUM 24 HO R gOS'q NCE NO'1'ICF REQUIFCED FOR 1::\SPECTIONS-PLEASE CALL(209)1953.7697 <br /> SIGNED / Lj TITLE_ Gnn�f«f n!` DATE l 3 O <br /> i <br /> ID <br /> FJ <br /> 1A1 I <br /> d <br /> a <br /> tir <br /> f1 g"I <br /> LLF <br /> DEPARTMENT U, ONj,Y D <br /> Application Aceeplzd �C"�/`�-- tete A. 2-4'-[ f, [/� A. EmylDyee fL)# ®(C <br /> Final Inspection 8 Date S��S^ ❑ SPECIAL PERMIT-Approved by_ 99 <br /> Character of&Aof 3 <br /> coMr,FNTs PitNump Soil Character: -.cs <br /> _ �� <br /> PF SC Received Checia Amount Permi <br /> DateCode INFO By Remitted ervice uest lavaice# Permit ID# <br /> j2_rr Irk 81(0 32-o-cno 3( <br /> 42-02-001 <br /> 1222,12003 ONSITE WASTEWATER PERMIT <br /> i <br />