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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY EN1,1IRON"WAL HEALTH OBPAR TMENT 1868 E. HAzFLToM AVENUE - STWKTON CA 9b20S - {209) 458-2420 <br />1 YEAR FROM <br />Jots ADDRESS <br />CROSS STREET tPARti£LS1U <br />APN L+..'...1._.W...._....-.._...,... <br />}} <br />OWNER NAME— � �6'.SLi�fTJ.�'CrhS � 1Li�sLL4� P"ow <br />OWNER ADDRESS CrtYIS7ATEiCaP <br />CONTRACTOR_"' (6-1 jr LrY4 C.._. PHONE C-oT i� <br />CONTRACTOR ADS -^ CITY1STATErLP , <br />LiCENffiE C3;,C-41 Doc-" OTHER � Numm^�,✓ 0 ? EXPIRATION DATE,___1.....�1.�`�"Z,�,' w . <br />WATER TAPE DEPTH; ft GEOGRAPHICAL INFORMAYlOW Coordinates X Y <br />CJ PERC TEST # BUILDING PIERWT # LAND USE APPLICATION # <br />T/PE OF NEI¢ WaTALLATKSIa REP AilAi jSITiON' - ENGINEER DEStGMEO JALTERNATNE <br />REPLACEMENT.. OUT -OR -SEANCE SEPTic SYSTEM D1:STRUCtIoN <br />} <br />INSTALLATION WILL SERVE: �RESIDENCE i -I COiAMERCIAL D OTHER 3 <br />1 NUMBER OF Llvwa LINtrB; NuMaER OP BeT»RiuiM"S, NUMBER OF EMPLOYEES: j <br />Q SEPTIC TANK TYPEMP13 CAPACITY _ £dal #OF COMPARTMENTS <br />rC1 GREASETRAP TYPEA&o CAPACITY gal *OFCOMPARTMENTS _ <br />OISTAWATONEAREST; WCi,I __ it FOUMXTION It PROPERTY LINE _-- __,..,...,_,.R <br />Q LIFT STATION SIZE TYPE OF PUW O PM TX PLANT 0 UNO 04L SEPARATOR (ENCLOSED SYSTEM) <br />Q <br />LEACH LINES 11 LEACHING CHAMBERS ___V_v, # OF UHeS _ LENGTH OFLINFS <br />R <br />ttrva>�ir# P`srrr�t liblN <br />Dtsur4ce TO NEAREST 1VFLL It r*M)NOATION ft PROPERTY LINE �.�!) <br />FILTER BED won, „ - ? _ A LENGTm '0r ft DEPTH 1 4 "f <br />" :?r=... - <br />_ it <br />It <br />DISTANCE TO NEAREST VdEUi.._ {. t j0! ± It rOIAMATION L Ot' ' ft PROPERTYume it <br />MOUNDED Wttrm It LENGTH It DEPTH <br />it <br />DISTANCE TO NEAREST AIELL It FOUNDATION __ft PROPERTY LINE <br />It <br />SUMPS 1*d oy%._.._._.....,..-.___...._._.._.._ q L&4anH ... .i! OfPTi't <br />it <br />DISTANCE To NEAREST VVF.L _ ft f OUWArtON ft PROPERTY UvE _ <br />it <br />O <br />DISPOSAL PONDS Worm ft LENCTH It DEPTH <br />ft <br />DISTANCE TO NEARM Wat ft FO N4DAT'IOA1 ft PROPERTY LINE <br />I1 <br />O <br />SEEPAGE PITS NU"ER__ VwarH R DEPTH <br />it <br />DISTANCE TO NEAREST V!£:"LLft F,-,1UN0A7!0N , ft PROPERTY! mr. <br />It <br />HERESY CERTIFY THAT i HAVE PREPARED TWS APPLICATION AND THE WORK MLL BE DOME IN ACCORDANCE VATH SAN JOAQUIN COUNTY ORDINANCE, <br />STATE LAWS AND RULES A140 REGULATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED <br />PLEASE CALL Ma) 953-76,97 <br />s <br />✓ d ✓� ✓ +`"- <br />TITLE DA f <br />■mlostmmotsONE ■ <br />++E - <br />��N <br />-as I e <br />1IM111111111 0 a I ■ ■�� <br />mons ����i� NAS ■ 0��:�� <br />111111111111"WINIMININ --I= I NNW <br />Application Accepted Date {f � Area � Employee 104 <br />Final Inspectdtm EY r _ _ _ .. - Date Q y �"�D $PEC AL PERMIT - AW -ed try <br />Character oY Soil to Depth of 3 A� L:31 _ PlttSump S+H 0waCtel': <br />jCode <br />10 <br />INFO RocofftdCCaehr 7 _ <br />�X7 <br />R.i tod sm"iic�ss R q �: <br />ttrva>�ir# P`srrr�t liblN <br />4"1 ONSITE WASTEWATER TRTWT SYSTEM PERMIT <br />4114119 15O"wL..%� v"TIr <br />