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42.01 <br />4/24,-12 <br />oNsiTE WASTEWATER TRTMNT SYSTEM PERMIT <br />0:24( v•hkhe.k 2.6 <br />art ,: "/: 34 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />'SAN JOAOLLIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HA/ELTON AVENUE • SroorroN CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERAK CALL (299)953-7607 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOE &DORM ir-1_7.4.#.1./2C-L5)_--__CLir_ CaTrZIP 4/Clextr-,%/S. <br />CROSS STREET _},45,__Eir _ <br />OwNEp NAME „S/4-41-C."4-Z., <br />OWNER ADDRESS _CM/STATE/ZIP <br />Cooatinaies X <br />CONTRACTOR C4,-,14,424° <br />CONTRACTOR ADDRESS 4P.37/4_ (*.it; <br />LICENSE )C.42 EJUC.36 OTHER <br />WATER TABLE DEPTN: (40 1.12-0 <br />CITY/STATE/IP <br />ir.„ EMMA nON DATE , <br />GEOGRAPNICAL INFORMATON: <br />PERC TEST BUILDING PERMIT LAND USE APPLICATKIN*_ „ <br />OUT-OP-SERVICE SEPTIC SysTEEI <br />ENGINEER OeseitIEDMATERRATNE <br />DESTRIXT1ON <br />TYPE OF WORK: jA, NEW INSTALLATOON <br />REPLACEMENT <br />COLIMERCLAL <br />CAPACil y gal <br />1 OTHER <br />NUMBER OF EMPLOYEES: <br />St. SEPTIC TANK <br />GREASE TRAP <br />TYPENEG 41,4 <br />TYPE/MEG <br />gal *Cf COmPARTMENTS <br />I Of COMPARTMENTS <br />CA:Aory <br /> <br />INSTALLATION WILL SERVE; RESIDENCE <br /> <br />NUMBER DE LIVING UNITS: <br />INSTANCE TO NEAREST WEI1,„,223- <br />LEACHING CHAMBERS <br />ft DEPTH <br />ft PROPERTY LINE <br />SAND OR. SEPARATOR (ENCLOSED SYSTEM) <br /> <br />ft PROPERTY LINE <br />DEPTH <br /> <br />PCUPDAT ft PROPERTY LOA, Jew <br />DEP"Ri E.Nto# <br />DISTANCE TO NEAREST WELL tt AflQi ft PROPERTYAA.I-IR <br /> ft DEM., • 5- <br />INSTANCE TO NEAREST wr u I 75- ft rouNDArion, <br />DISTANCE TO NEAREST <br />WIDTH _ <br />DISTANCE TO NEAREST <br />SUMPS WIDTH .. It LENGTH <br />DISTANCE TO NEAREST WELL <br />DISPOSAL PONDS Rfloni ft LENGTH <br /> ft <br />-A4Y fl <br />mEib.ft <br />WEIL ft FOL/NOATION ft PROPERTY LINE <br />ft LENGTN It DEPTH <br />WELL ft FOUNDATION <br />LIFT STATION <br />1. LEACH LINES <br />FILTER BED <br />a MOUNDED <br />a. SEEPAGE PITS <br /> *Dr LINES 3 LENGTH OF UNES _ ft <br />FouNOATIoN TA' ft PROPERTY LINE JO <br />- DISTANCE TO NEAREST: WELL FOuNDATICAN <br />SIZE TYPE OF PUMP 0 PKG TX PLANT 0 <br />HAT i NAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY, <br />ADVANCE Nonce REQUIRED FOR INSPECTIONS - PLEASE CALLi269 9 <br />TITLE e-e-f,A• DATE <br />HERESY CERTIl ORDINANCES, <br />-7597 <br />rai NOM _ NM Mil 11111•11111111 III • 1 1/1111 1116 <br />Ilklifill111111111111 111111101111W1 <br />lomemmorimum <br />111111.411111111111MINIMPEi_e_meiTAI. <br />PNAMINOMM1111111111111111111111111111111111111111111111111 <br />in AIBIIIMIUIIIIUIPOIIIMPNIIMIIIINIIMIIHIIIIUIIIIIUIIIMIIOIIIIIIIIIIIIIIIII <br />IIIIIIIOIIIIIIIIIIIIIOMNNIIIMIIIIIIIIIIIIIIIIIIIIIII 1111111111111111111111111111111111 ail <br />gm MIME <br />11111111111•11111111111BMIC <br />' 2111111111 um mu uaauuuua••auuu <br />a • III " FAMIIIIMOINIUsemol DM 11111111111•11111111111111111111 <br />1110111110111 ' " 111 If! IIIIIIMIIMIIII <br />Igireed IIII 111•1•11millarl -• 1111111111.11111••••• <br />I. I <br />iPC <br />0 <br />Received <br />a <br />Amount <br />Re <br />Perrmt/ i a Request <br />. Permit ID/ <br />Li Ctaóe <br />4' / ".9 7 4 i Ailltr jOO 74JO3 , <br />i <br />Application Accept <br />Final Inspection <br />Character of Soil to Dtth of 3 Ft: <br />COMMENTS °Ls? <br />Area <br />n SPECIAL PERMIT - APPPOWed <br />il Character: <br />PARCEL SGE • APN 121g-7-420 5