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Cm/STA-ream
<br />PHONE f.16
<br />RIM Ell T.
<br />Oats Area Employee ID*
<br />U SPECIAL PERMIT Approved by I
<br />ti SOU Character:
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<br />Application Acorpted By
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<br />Character of Soil to pth of 3 Ft:
<br />COMMENTS 431ifgLI
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<br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SOO E MAIN STREET -STOCKTON CA95202 -1209)40-3420
<br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM (METE ISSUED
<br />Joe ADDRESS „fie. 4> ,..4, "..1 re1-1%.0 ..4e4.1 CITY/ZIP ‘S",74,P.A.
<br />clans STREET elcy,41.-4,0o/ 5 ARM (05- 04(4 -15 PARCEL SIZE tal2k.___
<br />OWNER NAME ........."-..),....,,,L, i'a
<br />OWNER ADORES'S
<br />CONTRACTOR
<br />Conmstion AconEss ...,e6•17.e7/t7 117/,--_./., -7- t CnvistsrEar
<br />LICENSE A,C42 1,IC-38 OTHER arA NUMBER '12, EXPIRATION DATE
<br />WATER TABLE DEPTH: ft
<br />, PERC TEST #
<br />_, DESTRUCTION
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<br />INSTALLATION WILL SERVE: 7,4' COMMERCIAL L.) OTHER
<br />TYPE/MFG ----.-..---. A ,
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<br />NUMBER OF iivLIVING UNITS: Noumea or BEonOuritS: NUMBER OF EMPLOYEES:
<br />;Er SEPTIC TANK L CPACITY 73 4.) gat # or COIAPARTMENTS 7
<br />GREASE TRAP Neu/MFG CAPACITY gal # OF COMPARTMENTS I
<br />/ ft PROPERTY LINE '5-4'1 (*STANCE TO NEAREST: WELL /70 ` it FOUNDATION ,,,,,p e) it
<br />X LIFT STATION SIZE TYPE OF PUN!' ..A-14..A.pU MG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM)
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<br />ON SITE WASTEWATER TREATMENT SYSTEM PERMIT - •
<br />PHONE ..47--2,3-7 3 I
<br />TYPE OF WORK: X, NEW INSTALIAncei
<br />o REPLACEMENT Li OUT-OF-SERVICE SEPTIC SYSTEM
<br />GEOGRAPHICAL INFORMATION: Coordinates X
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<br />BUILDING PERMIT :,,t* Pr` 1 /177 LAND USE APPUCATION #
<br />EPAIRIADOITION u ENGINEER DESIGNED /ALTERNATIVE
<br />FILTER BED WIDTH ft LENGTH ft DEPTH. I ft
<br />' DISTANCE TO NEAREST WELL ft FOP4 ft PROPERTY LINE I ft
<br />MOUNDED WIDTH ft LENGTH ft DEPTH
<br />L DISTANCE TO NEAREST . WELL ft FOUNDATION ft PROPERTY LINEE . ft
<br />SUMPS WIDTH ft LENGTH ft Deem
<br />DISTANCE TO NEAREST WELL ft FourcAtioN ft PROPERTY LINE ft
<br />DISPOSAL PONDS WIDTH ft • LENGTH ft DEPTH ft
<br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 4 ft
<br />14 SEEPAGE PITS Numalict ,t'er'' Worm 1' . ft DEPTH 7.-r-S-- ' ! ft
<br />DISTANCE TO NEAREST WELL __2,,,c7,),,.:',4_ ft FOUNDATION ” 0 6 41. ft PROPERTY LINE ft ft
<br />
<br />4 LEACH LINES J LEACHING CHAMBERS
<br />DISTANCE TO NEAREST WELL UP, ft FOUNDATION -"AO
<br /># OF LINES 7- LENGTH Of LP4E3 4-0
<br />ft PROPERTY LrNE,r;A.
<br />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 REGULATIONS OF SAN JOAQUIN COUNTY.
<br />MINI M 24 H09, A1_4231/ NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL. (209)953-7697
<br />SIGNED TITLE <LEW DATE.../Z. -</Let)9
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<br />Check#0 . Amount
<br />Remitted Date PeTrait/
<br />Service Request # Invoice # Permit ION
<br />42-16' 2.150 LiARINF. s:, 0. ..1_0_1...../* I
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<br />42-01
<br /> °NETTS WASTEWATER TRIMNT.SYSTEM PERMIT
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